C95 COPD ADVANCES IN THERAPY / Mini Symposium / Tuesday, May 23/2:15 PM-4:15 PM / Ballroom B (South Building, Level 3) Walter

E. Washington Convention Center

Ics Withdrawal And Treatment With A Fixed-Dose Laba/lama Combination: The German Real-Life
Daccord COPD Cohort

H. Worth1, R. Buhl2, C.-P. Criee3, P. Kardos4, N. S. Lossi5, C. Mailander5, C. Vogelmeier6

1Facharztforum Frth, Furth, Germany, 2University Hospital Mainz, Mainz, Germany, 3Evangelical Hospital Goettingen-Weende,

Bovenden, Germany, 4Red Cross Maingau Hospital, Frankfurt, Germany, 5Novartis Pharma GmbH, Nuremberg, Germany, 6University of
Marburg, Marburg, Germany

Corresponding author's email: nadine.lossi@novartis.com

Rationale
The prospective, non-interventional DACCORD study is collecting data over 2 years from a cohort of COPD patients recruited in primary
and secondary care across Germany who either initiated or changed COPD maintenance medication prior to entry. Following the approval
of LABA/LAMA fixeddose combinations (FDCs) in 2013, DACCORD was broadened to also follow a cohort of patients receiving a regimen
containing any LABA/LAMA FDC. Here, we report 1-year follow-up data of a subgroup of patients of this 2 nd cohort who discontinued
ICS-containing therapy at study entry and initiated a LABA/LAMA-FDC based therapy instead.
Methods
Baseline demographics were collected and COPD severity determined (GOLD 2011). The number of exacerbations was collected over 6
months prior to study entry and every 3 months during the course of the study. Current COPD medication was recorded at each visit.
Health status was assessed at baseline and after one year using the COPD Assessment Test (CAT).
Results
Of 4227 patients in the 2nd cohort with 1-year data, 766 discontinued ICS and initiated LABA/LAMA FDC on entry to DACCORD (58% male,
mean age 67.2 years, baseline mean FEV1 63.4% predicted). In this subgroup, prior to study entry 58% of patients were receiving
LABA+ICS, 31% LABA+LAMA+ICS, 4.7% ICS Monotherapy, 4.3% a Theophylline and/or PDE4-containing regimen in addition to ICS, 2.0%
LAMA+ICS. In the 6 months prior to study entry, 27.9% reported at least one exacerbation. Despite ICS discontinuation, only 19.5%
patients exacerbated during the 1-year follow-up (annualized exacerbation rate 0.28 events/patient/year- compared to 0.30 of the total
population). Exacerbations were evenly spread across the one year observational period (6.5%, 5.2%, 7.0% and 7.2% in the first, second,
third and fourth quarters, respectively). At baseline, 43.9% of patients were GOLD Category B, compared with 60.8% at year 1, with the
percentage in GOLD Category D decreasing from 46.3% at baseline to 24.7% at year 1. The mean CAT total score improved from 20.0 at
baseline to 17.2 at year 1.
Conclusions
Several recent interventional studies have analyzed the effect of ICS withdrawal in COPD. Here, we extend these findings into a real-life
cohort, to show that ICS withdrawal followed by initiation of a LABA/LAMA FDC did not lead to an increase in exacerbations in the
following year and was associated with an improvement in health status.

This abstract is funded by: Novartis Pharma GmbH,Germany

Am J Respir Crit Care Med 2017;195:A6743
Internet address: www.atsjournals.org Online Abstracts Issue