GSK’s closed triple in COPD faces pulmonologist resistance on ICS use but GP generous prescribing to drive market

30 Mar 2017

GlaxoSmithKline’s (LON:GSK) closed triple FF/UMEC/VI combination carries dampened enthusiasm for use in chronic obstructive pulmonary disease (COPD)with questionable risk/benefit profile of the inhaled corticosteroid (ICS), experts said.

The closed triple is a once-daily inhaler with an inhaled corticosteroid (ICS)/long acting muscarinic antagonist (LAMA)/ long acting beta agonist (LABA) combination of GSK’s Flovent (fluticasone), Incruse (umeclidinium) and vilanterol, respectively.

Interviewed experts said the field had moved beyond using ICS as a part of combinations with LABAs or by themselves due to a perceived lack of benefit coupled to pneumonia risk, and LABA/LAMA combinations are the preference. This has reined in the assumption that triple LABA/LAMA/ICS combinations would be the go-to effective choice for all COPD patients, they added.

While experts said COPD patients with a history of multiple exacerbations could still benefit from an ICS being a part of a triple therapy, the availability of FF/UMEC/VI could spur indiscriminate usage among all COPD patients. This would especially be an issue among non-specialists or general practitioners who may not conduct routine lung function spirometry tests to confirm a COPD diagnosis to appropriately select medications.

GSK filed for a US approval of the closed triple combo in November 2016, and analysts expect an approval in 2H17. This news service reported on 29 March that GSK’s closed triple is likely to be approved and find broad acceptance among patients already on an open triple therapy -- a LABA/ICS combination and a LAMA in two separate inhalers -- and ease of use and better compliance would spur uptake.

While the market remains positive on approval, some are mixed on uptake prospects due to a competitive field and slow uptake with dual combinations in the past. Analysts have predicted peak sales for the closed triple to be USD 2bn by 2028.

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