Triple combination asthma inhaler works in patients with persistent airflow limitation

A novel once-a-day inhaler for asthma that contains a fixed-dose combination of the corticosteroid mometasone furoate (MF), the long-acting beta-agonist indacaterol acetate (IND), and the long-acting muscarinic antagonist glycopyrronium bromide (GLY) appears to have a favourable effect in patients with persistent airflow limitation (PAL), according to a post hoc analysis of the IRIDIUM study.

The analysis involved 3,092 patients with asthma who participated in the IRIDIUM study. Of these, 1,981 patients (64 percent) had postbronchodilator FEV1 of ≤80 percent of predicted and FEV1/FVC ratio of ≤0.7 and were categorized as having PAL.

Lung function parameters, such as FEV1, PEF, and FEF 25%–75%, as well as annualized asthma exacerbations rates were evaluated and compared in the PAL and no PAL subgroups across the following treatment arms: once-daily high-dose MF/IND/GLY (160/150/50 μg), high-dose MF/IND (320/150 μg), and twice-daily high-dose fluticasone/salmeterol (FLU/SAL; 500/50 μg).

Results showed no evidence of treatment difference between PAL and non-PAL subgroups in terms of FEV1 (p=0.42), FEF25%–75% (p=0.08), PEF (p=0.43), moderate or severe exacerbations (p=0.29), severe exacerbations (p=0.35), and all exacerbations (p=0.12).

In the PAL subgroup, patients who received high-dose MF/IND/GLY vs those who received  showed high-dose MF/IND and high-dose FLU/SAL showed significantly greater improvements in trough FEV1 (mean difference, 102 and 137 mL, respectively; p<0.0001 for both) and reductions in the frequencies of moderate or severe (difference, 16 percent and 32 percent), severe (difference, 25 percent and 39 percent), and all exacerbations (difference, 19 percent and 38 percent).