Treating to the Phenotype: Fixed-Dose Combinations and Triple Therapy

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The MD Magazine Peer Exchange “Expanding Treatment Options: The Latest Developments in COPD Therapy” features a panel of physician experts discussing key topics in COPD therapy, including risk factors, personalized treatment, preventive measures, new combination therapies, and more.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Byron Thomashow, MD, professor of medicine at Columbia University Medical Center, medical director at the Jo-Ann LeBuhn Center for Chest Disease at New York-Presbyterian Hospital, and chairman of the board of the COPD Foundation
• Neil R. MacIntyre, MD, clinical chief of the Pulmonary/Critical Care Division, medical director of Respiratory Care Services, and professor of medicine at Duke University School of Medicine
• Barry J. Make, MD, director of Pulmonary and Respiratory Care for National Jewish Health and professor of medicine at the University of Colorado School of Medicine
• Nicola A. Hanania, MD, MS, associate professor of medicine and director of the Asthma and COPD Clinical Research Center at Baylor College of Medicine

Without head-to-head clinical trial data, it is unknown which type of fixed-dose combination therapy is superior: LABA/corticosteroid or LABA/LAMA. It is also unknown which should be prescribed first, said Hanania, going on to describe scenarios based on phenotype of when each option would be more appropriate.

While triple therapy has been the mainstay of COPD regimens in pulmonologist practices, where the sickest patients are treated, Thomashow acknowledged that they have made a difference to many patients, but that he has made an effort to move away from triple therapy and toward combination LAMA/LABA therapy.