Late Breaking Abstract - Promptly escalating to budesonide/glycopyrronium/formoterol from dual therapy reduces exacerbations and cardiopulmonary events in patients with COPD (MITOS EROS+CP study)

<bold>Rationale:</bold> Timely escalation from dual to triple therapy reduces risks of acute COPD exacerbations (AECOPD). This study examined whether prompt escalation of budesonide/glycopyrronium/formoterol fumarate (BGF) from dual therapy following an AECOPD also lowers risk of 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 escalated from dual therapy to BGF within 1-year following index. Outcomes were annualized rates of AECOPD and CP events. 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> 10103 patients qualified: 1122 prompt, 4064 delayed, and 4917 very delayed. The rate per person/year (95% CI) of post-index AECOPD increased as the time to BGF escalation increased: prompt 1.42 (1.36–1.49); delayed 1.86 (1.82–1.89); and very delayed 2.06 (2.03–2.09). Total CP event rates were: prompt 0.31 (0.28–0.34); delayed 0.38 (0.37–0.40); and very delayed 0.36 (0.34–0.37). <bold>Conclusion:</bold> Promptly escalating to BGF from dual therapy was associated with 23% and 31% fewer subsequent AECOPD and 19% and 13% fewer CP events compared with delayed and very delayed groups. Proactive disease management with BGF may be warranted to prevent future AECOPD and cardiopulmonary events among patients with COPD.