The following is a summary of “Efficacy of once-daily, single-inhaler, fixed-dose combination of mometasone/indacaterol/glycopyrronium in patients with asthma with or without persistent airflow limitation: Post hoc analysis from the IRIDIUM study,” published in the MAY 2023 issue of Pulmonology by Zyl-Smit, et al.

For a study, researchers focused on the efficacy of a new inhaler medication, called mometasone furoate/indacaterol acetate/glycopyrronium bromide (MF/IND/GLY), in treating asthma patients who were not adequately controlled on a different medication combination of inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA). The medication is delivered via a device called Breezhaler®. It is the first to combine an ICS, a LABA, and a long-acting muscarinic antagonist (LAMA) in a fixed-dose, once-daily combination. The study analyzed data from the IRIDIUM study and included patients with asthma and persistent airflow limitation (PAL) and those without. 

Patients with post-bronchodilator forced expiratory volume in 1 second (FEV₁) ≤80% of predicted and an FEV₁/forced vital capacity (FVC) ratio of ≤0.7 were classified as the PAL subgroup, while the remaining patients were classified as the non-PAL subgroup. The study evaluated lung function parameters (FEV₁, peak expiratory flow [PEF], and forced expiratory flow at 25%-75% of FVC [FEF_25%-75%]) and annualized asthma exacerbation rates across three treatment arms: high-dose MF/IND/GLY, high-dose MF/IND, and high-dose fluticasone/salmeterol (FLU/SAL) given twice daily. 

Of the 3,092 patients who were randomly assigned, 64% (n = 1,981) met the PAL requirements. In general, there was no indication that the PAL and non-PAL categories received different therapy (the interaction P-values for FEV₁, FEF_25%-75%, PEF, moderate or severe exacerbations, severe exacerbations, and all exacerbations were 0.42, 0.08, 0.43, 0.29, 0.35, and 0.12, respectively). High-dose MF/IND/GLY versus high-dose MF/IND and high-dose FLU/SAL enhanced trough FEV₁ in the PAL subgroup and decreased moderate or severe (16% and 32%), severe (25% and 39%), and all exacerbations (19% and 38%), respectively (mean difference: 102 mL [P< 0.0001] and 137 mL [P< 0.0001].

The study concluded that once-daily fixed-dose MF/IND/GLY was an effective treatment option for asthma patients with and without persistent airflow limitation.

Reference: resmedjournal.com/article/S0954-6111(23)00060-4/fulltext