Triple inhaled therapy for asthma in Canada

Abstract

A significant number of patients with asthma have poor control on their current inhaled therapies, typically a combination of inhaled corticosteroids (ICS) and long-acting beta-2 adrenergic bronchodilators (LABA). Adding a long-acting antimuscarinic agent (LAMA) has been shown to improve asthma control and the availability of triple therapy formulations (ICS/LABA/LAMA) in a single inhaler device or single inhaler triple therapy (SITT) mitigates the adherence concerns associated with use of multiple inhaler devices. Here, we provide an overview of the pivotal data concerning the use of triple asthma therapy in patients with poor control on ICS-LABA treatment, and present our expert approach to their application in the routine clinical management of such patients as well the appropriate sequencing of initiating triple therapy and seeking a referral for consideration of more advanced therapies.

RÉSUMÉ

Un nombre important de patients asthmatiques ont un faible contrôle sur leurs traitements inhalés actuels, généralement une combinaison de corticostéroïdes inhalés (CSI) et de bronchodilatateurs bêta2 adrénergiques à action prolongée (LABA). Il a été démontré que l'ajout d'un agent antimuscarinique à action prolongée (LAMA) améliore la maitrise de l'asthme et que la disponibilité de formulations de trithérapie (ICS/LABA/LAMA) dans un seul inhalateur ou une trithérapie à inhalateur unique (SITT) atténue les problèmes d'observance associés à l'utilisation de plusieurs inhalateurs. Nous donnons ici un aperçu des données pivots concernant l'utilisation de la trithérapie de l'asthme chez les patients ayant un faible contrôle sur le traitement ICS-LABA, et présentons notre vision d’experts concernant leur application dans la prise en charge clinique de routine de ces patients ainsi que le séquençage approprié de l'initiation de la trithérapie et de la recherche d'une référence pour envisager des thérapies plus avancées.

Keywords:

• Canadian health system
• long-acting muscarinic antagonists
• single inhaler triple therapy
• uncontrolled asthma

Acknowledgment

The authors would like to thank John Howell PhD of John Howell Consulting, Inc., for providing medical writing and editorial support.

Author contributions

All authors contributed to the conceptualization, writing, review and editing of this manuscript.

Disclosure statement

M. Balter has served on advisory boards for AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck, Novartis, Sanofi-Genzyme and Valeo Pharma and has received honoraria as a speaker for AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, ICEBM, Novartis and Valeo Pharma.

S. Bhinder has received honoraria as a speaker from Boehringer-Ingelheim, AstraZeneca, Merck/Organon, Novartis, Bayer, GlaxoSmithKline, Covis, Sanofi and Valeo; has served on advisory boards for AstraZeneca, Boehringer-Ingelheim, Novartis, GSK, Covis and Sanofi; and has received consulting fees from AstraZeneca, Boehringer-Ingelheim, Novartis, GlaxoSmithKline, Covis and Sanofi.

K. R. Chapman has received honoraria as a speaker for AstraZeneca, Boehringer-Ingelheim, Grifols, GlaxoSmithKline, Merck Frosst, Novartis, Sanofi, Takeda and Valeo Pharma; consulting fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, GlaxoSmithKline, Grifols, InhibRx, Kamada, Merck Frosst, Novartis, Regeneron, Roche, Sanofi, Takeda and Valeo Pharma; and research grants from Amgen, AstraZeneca, CSL Behring, Bellus, Bristol Meyers Squibb, Genentech, GlaxoSmithKline, Gossamer, Grifols, Kamada, Novartis, Regeneron, Roche and Sanofi.

K. Godbout has received honoraria as a speaker from Astrazeneca, Covis, GlaxoSmithKline, Merck, Novartis and Sanofi; consulting fees from Astrazeneca, Covis, GlaxoSmithKline, Novartis, Sanofi and Valeo; and research grants from Astrazeneca, Novartis and Sanofi.

A. Kaplan has received speaking engagement, honoraria and consulting fees from Astra Zeneca, Boehringer Ingelheim, Cipla, Covis, Eisai, GlaxoSmithKline, Pfizer, NovoNordisk, Novartis, Grifols, Teva, Trudell, Valeo, Sanofi and Valeo Pharma, and research grants from Novartis, Boehringer Ingelheim.

A. McIvor has received honoraria as a speaker from AstraZeneca, Boehringer Ingelheim, Grifols, Merck, Novartis, Takeda, Teva and Sanofi Valeo Pharma. He has participated in advisory boards and received consulting fees from AstraZeneca, Boehringer Ingelheim, GSK, Pfizer, Merck, Novartis, Takeda, Teva and Valeo and received research grants from AstraZeneca, Novartis.

P. Papadopoulos is a former employee of Valeo Pharma Inc.

Additional information

Funding

The development of this manuscript was supported by Valeo Pharma. No payments were made for authorship.