Late Breaking Abstract - Prompt initiation of budesonide/glycopyrronium/formoterol reduces exacerbations and cardiopulmonary events in patients with COPD (MITOS EROS+CP study)

<bold>Rationale</bold>: Timely initiation of therapy reduces risks of acute COPD exacerbations (AECOPD). This study examined whether prompt initiation of single inhaler triple therapy (SITT) with budesonide/glycopyrronium/formoterol fumarate (BGF) following an AECOPD also lowers risk of future AECOPD and severe cardiopulmonary (CP) events. <bold>Methods:</bold> This retrospective study used US claims data from patients with COPD who were ≥40 years with no prior SITT and either: ≥1 severe or ≥2 moderate AECOPD, or ≥1 moderate AECOPD while on non-SITT treatment (earliest event = index date); all patients initiated BGF within 1-year following index. Outcomes were annualized rates per person/year of AECOPD and severe CP events. Severe CP events included mortality, severe AECOPD and hospitalizations for HF, AMI, and cardiac arrest. Descriptive results were presented and stratified by BGF initiation: prompt (≤30 days), delayed (31–180 days), and very delayed (181–365 days). <bold>Results:</bold> 17613 patients qualified: 2192 prompt, 7230 delayed, and 8191 very delayed. The rate per person/year (95% CI) of post-index AECOPD increased as the time to BGF initiation increased: prompt 1.35 (1.30–1.40); delayed 1.77 (1.74–1.79); and very delayed 1.98 (1.95–2.00). Total severe CP event rates were: prompt 0.34 (0.32–0.37); delayed 0.39 (0.38–0.40); and very delayed 0.38 (0.37–0.39). <bold>Conclusion</bold>: Promptly initiating BGF was associated with 24% and 32% fewer subsequent AECOPD and 12.3% and 9.3% fewer severe CP events compared with delayed and very delayed groups. Proactive disease management with BGF may be warranted to prevent future AECOPD and CP events among patients with COPD.