S115 Efficacy of high-dose triple therapy on asthma exacerbations in asthmatics with persistent airflow limitation and high blood eosinophil count: a post-hoc analysis of the TRIGGER study

• Published in: Thorax Vol. 78; no. Suppl 4; pp. A82 - A83
• Main Authors: Kots, MK, Papi, AP, Fabbri, LF, Canonica, GWC, Deijl, MvD, Vele, AV, Topole, ET, Georges, GG
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 06.11.2023; BMJ Publishing Group LTD
• Subjects: Asthma; Blood; Immunotherapy; Inhalers; ‘The winner takes it all’ – Therapy in asthma
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2023-BTSabstracts.121

BackgroundHigh-dose triple therapy with ICS/LABA/LAMA is recommended for adults with uncontrolled asthma in GINA Steps 4–5 and is often administered concomitant with or prior to initiation of biologic treatment. Previously, we reported in a post-hoc analysis of two large randomized clinical trials (TRIMARAN & TRIGGER) that patients with asthma uncontrolled on ICS/LABA and exhibiting persistent airflow limitation (PAL) may particularly benefit from the addition of LAMA (Singh D et al. Eur Respir J 2020). Here we explore the efficacy of high-dose ICS triple therapy in patients not controlled by high-dose ICS/LABA exhibiting both PAL and high blood eosinophil count, a phenotype that is considered for a step-up to biologic therapy.MethodsUsing the dataset from the TRIGGER study, we conducted a post-hoc analysis in subjects with asthma uncontrolled by high dose ICS/LABA exhibiting PAL (post-salbutamol FEV1≤80% and FEV1/FVC≤0.7) and a blood eosinophils count higher than 150 cell 109/L at screening, to evaluate the annualized rate of moderate to severe exacerbation following a 52 week treatment with high-dose extrafine beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/GB 800mcg/24mcg/50mcg total daily dose pMDI) or high dose extrafine beclometasone dipropionate/formoterol fumarate (BDP/FF 800mcg/24mcg total daily dose pMDI).ResultsThe TRIGGER study population included 1142 patients on BDP/FF/GB or BDP/FF out of which 511 (44.7%) met the criteria of PAL and high blood eosinophil count. After 52 weeks of therapy, the reduction in the rate of ‘severe’ and ‘moderate and severe’ asthma exacerbations with BDP/FF/GB vs BDP/FF was 35.8% (rate ratio = 0.642; 95% CI: 0.445–0.926; p=0.018) and 28.3% (rate ratio = 0.717; 95% CI: 0.573–0.898; p=0.004), respectively.ConclusionTreatment with high-dose extrafine BDP/FF/GB is effective in patients with asthma uncontrolled on high-dose ICS/LABA who exhibit PAL and high blood eosinophils count. Exploring triple therapy before initiation of biologic treatment is an option that merits further investigation.Please refer to page A287 for declarations of interest related to this abstract.