LOHANA, ABHI

Background/Objectives: Fixed-dose triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) at high risk of exacerbations; however, direct comparative effectiveness data between available triple therapy regimens remain limited. We compared real-world clinical outcomes among adults with COPD receiving fluticasone furoate/vilanterol/umeclidinium (FF/VI/UMEC) or budesonide/glycopyrrolate/formoterol (BUD/GLY/FOR). Methods: We conducted a retrospective propensity score-matched cohort study using the TriNetX Research Network. Adults with a spirometrically confirmed diagnosis of COPD who received fluticasone furoate/vilanterol/umeclidinium (FF/VI/UMEC) or budesonide/glycopyrrolate/formoterol (BUD/GLY/FOR) between July 2020 and August 2024 were included in the analysis. A 365-day landmark period was applied to establish maintenance therapy, with outcome follow-up beginning 1 year after treatment initiation. Patients were followed for outcomes through August 2025, the date of database analysis. After 1:1 propensity score matching, treatment groups were compared for COPD exacerbations, acute respiratory failure (ARF), hospitalization, and all-cause mortality using RR and Cox proportional hazards analyses. Results: In matched cohorts, FF/VI/UMEC was associated with a significantly higher risk of COPD exacerbations (5.6% vs. 3.9%; RR 1.44; 95% CI 1.30–1.59; p < 0.001) and ARF (2.5% vs. 1.9%; RR 1.28; 95% CI 1.11–1.46; p < 0.001) compared with BUD/GLY/FOR. Time-to-event analyses demonstrated lower event-free probability for exacerbations (HR 1.35; (95% CI 1.21–1.50) and ARF (HR 1.15; (95% CI 1.00–1.32))). All-cause mortality was numerically higher in the FF/VI/UMEC cohort (5.2% vs. 4.7%; RR 1.09; 95% CI 1.00–1.19; p = 0.050); however, time-to-event analysis did not demonstrate a statistically significant difference. Hospitalization rates were similar between groups. Conclusions: In this large propensity score-matched real-world cohort study, patients receiving BUD/GLY/FOR experienced lower rates of COPD exacerbations and acute respiratory failure than those receiving FF/VI/UMEC. Because of the retrospective observational nature of the analysis, these findings should be considered hypothesis-generating and require confirmation in prospective comparative effectiveness studies.

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to severe respiratory infections. While COVID-19 vaccination has demonstrated effectiveness in reducing severe disease in the general population, its real-world impact on clinical outcomes among COPD patients remains underexplored. Understanding these outcomes could strengthen vaccination advocacy and guide COPD management strategies. Research Question Does COVID-19 vaccination reduce the risk of mortality, COPD exacerbations, and mechanical ventilation in adults with COPD? Methods We conducted a retrospective, propensity-matched cohort study using the TriNetX US Collaborative Network, which aggregates de-identified electronic health records from 72 healthcare organizations. Adults with COPD were identified using ICD-10 code J44 and spirometric confirmation (FEV1/FVC ≤ 70%). Cohorts were divided by COVID-19 vaccination status, identified through CPT and RxNorm codes. The index date was defined as the earliest qualifying encounter, with outcomes assessed thereafter.Primary outcome was all-cause mortality; secondary outcomes included COPD exacerbation (J44.1) and mechanical ventilation (ICD-10-PCS 5A1945Z). Propensity-score matching (1:1) was performed on age, sex, race, comorbidities, and baseline clinical characteristics, yielding balanced cohorts (n = 3,969 each). Risk ratios (RR), hazard ratios (HR), and Kaplan-Meier survival analyses were calculated, with significance set at p &lt; 0.05. Results After matching, median follow-up was 894 days for the unvaccinated group and 886 days for the vaccinated group. All-cause mortality 23.8% (942/3,954) in unvaccinated vs 11.1% (442/3,968) in vaccinated; RR 2.14 (95% CI 1.93-2.37); HR 1.80 (95% CI 1.60-2.02); p &lt; 0.001. COPD exacerbations 31.3% (1,243/3,969) in unvaccinated vs 25.3% (1,006/3,969) in vaccinated; RR 1.24 (95% CI 1.15-1.33); HR 1.24 (95% CI 1.14-1.35); p &lt; 0.001. Mechanical ventilation 1.8% (72/3,902) in unvaccinated vs 0.8% (30/3,928) in vaccinated; RR 2.42 (95% CI 1.58-3.69); HR 2.06 (95% CI 1.33-3.18); p = 0.001. Kaplan-Meier curves demonstrated consistently higher survival and event-free probabilities among vaccinated patients across all outcomes. Conclusions In this large, real-world analysis, COVID-19 vaccination was associated with significantly lower risks of all-cause mortality, COPD exacerbations, and need for mechanical ventilation. These findings emphasize the importance of vaccination as a key component of COPD care, supporting its inclusion in quality-improvement metrics and clinical counseling for patients with chronic lung disease. This abstract is funded by: None

Abstract Background Obesity contributes to worse symptoms and exacerbations in chronic obstructive pulmonary disease (COPD). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve weight and metabolic profiles and have emerging pulmonary benefits. However, their real-world impact on respiratory outcomes in patients with COPD and obesity is not well established. Research Question Among obese adults with COPD, is GLP-1 RA use associated with reduced risk of COPD exacerbations, acute respiratory failure, and all-cause mortality compared with those not receiving GLP-1 therapy? Methods We conducted a retrospective, propensity-matched cohort study using the TriNetX U.S. Collaborative Network. Adults aged ≥40 years with COPD (ICD-10 J44) and BMI ≥30 kg/m² were included. The exposed cohort comprised patients prescribed GLP-1 RAs (lixisenatide, albiglutide, dulaglutide, liraglutide, semaglutide, or exenatide), while comparators had no exposure. The index event was the first date meeting inclusion criteria. Outcomes were analyzed beginning 180 days after index to minimize reverse causation, excluding those with prior events. Propensity score matching (1:1) balanced demographics, comorbidities, laboratory data, and medication use, yielding 2,795 patients per group. Primary outcomes included the risk (≥1 event within window) of COPD exacerbation, acute respiratory hypoxic and/or hypercapnic failure leading to hospitalization, and all-cause mortality. Risk difference (RD), risk ratio (RR), and odds ratio (OR) were calculated; Kaplan-Meier and log-rank testing assessed time-to-event. Results After matching, baseline characteristics were well balanced. GLP-1 RA use was associated with significantly lower risk across all outcomes:COPD Exacerbation (J44.1): 18.2% (No GLP-1) vs 11.2% (GLP-1); RD 7.0%, RR 1.63 (95% CI 1.36-1.94); p = 0.042.Acute Hypoxic and/or Hypercapnic Respiratory Failure (J96.x): 19.2% vs 11.5%; RD 7.7%, RR 1.67 (1.42-1.96).All-Cause Mortality: 14.6% vs 7.6%; RD 7.0%, RR 1.92 (1.64-2.25); p = 0.010. Kaplan-Meier survival analysis demonstrated significantly improved survival in the GLP-1 group for mortality and COPD exacerbation outcomes. Conclusions In obese adults with COPD, GLP-1 RA therapy was associated with clinically and statistically significant reductions in COPD exacerbations, acute respiratory failure, and all-cause mortality. These findings suggest that GLP-1 RAs may offer dual metabolic and pulmonary benefits and warrant evaluation as adjunctive therapy in future prospective trials. This abstract is funded by: None

Abstract Introduction: Chronic Obstructive Pulmonary Disease (COPD) exacerbations increase inflammation, immobilization, and thrombotic risk, leading to a higher incidence of pulmonary embolism (PE). This study evaluates the incidence and risk of PE in patients with acute exacerbations of COPD (AECOPD) compared to those without exacerbations. Methodology: This retrospective cohort study utilized data from 94 healthcare organizations, identifying two cohorts: patients with AECOPD and those without exacerbations. Inclusion was based on ICD-10-CM codes, and individuals with malignancies, coagulation disorders, or prior PE were excluded. Propensity score matching was performed to balance the cohorts on demographics, clinical characteristics, and medications. The primary outcome was PE incidence, analyzed using risk differences, risk ratios, odds ratios, and Kaplan-Meier survival analysis to evaluate mortality outcomes associated with PE. Results: After matching, both cohorts comprised 174,345 patients each. The mean age was approximately 73 years, with a slight female predominance (49.0% in AECOPD vs. 49.3% in non-AECOPD). The incidence of PE was significantly higher in the AECOPD cohort (15%) compared to the non-AECOPD cohort (8%) (p &lt; 0.001). Specifically, 2,162 patients (1.3%) in the AECOPD cohort developed PE, compared to 1,467 patients (0.9%) in the non-AECOPD cohort. The risk difference was 0.004 (95% CI: 0.003, 0.005; p &lt; 0.001). The risk ratio for PE in the AECOPD cohort was 1.477 (95% CI: 1.382, 1.577), and the odds ratio was 1.483 (95% CI: 1.387, 1.585). Survival analysis revealed a probability of 95.23% in the AECOPD cohort and 97.15% in the non-AECOPD cohort, with significant differences (χ² = 153.746, df = 1, p &lt; 0.001). The hazard ratio for mortality associated with PE was 1.517 (95% CI: 1.419, 1.621). Conclusion: Patients with AECOPD have a significantly higher incidence of pulmonary embolism compared to those without exacerbations. PE is often overlooked in AECOPD patients due to the overlap in clinical symptoms, making timely diagnosis and treatment challenging. This can result in delayed management and poor outcomes. Therefore, it is crucial to enhance understanding of the clinical manifestations, diagnosis, and treatment of COPD complicated by PE to improve diagnostic accuracy, ensure timely intervention, and optimize patient prognosis.

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) represents a significant global health challenge, particularly in its moderate to severe cases, where effective management is crucial to improving patient outcomes. The integration of inhaled corticosteroids with long-acting β2-adrenoceptor agonists and long-acting muscarinic antagonists in fixed-dose combinations has emerged as a cornerstone of therapy. This study evaluates the efficacy of two triple therapy regimens — Glycopyrrolate, Budesonide, and Formoterol Fumarate (GLY/BUD/FOR) and Fluticasone Furoate, Vilanterol, and Umeclidinium (FF/VI/UMEC) —in adults aged 45 and older with diagnosed COPD with FEV1/FVC &lt; 70% to assess the impact of these regimens on the preventing COPD exacerbations and acute hypoxemic respiratory failure. Methods: A retrospective cohort analysis was conducted using the TriNetX database. Patients with moderate to severe COPD and FEV1/FVC &lt; 70% were identified based on ICD codes, and two cohorts were formed based on the prescribed inhaler therapy: GLY/BUD/FOR and FF/VI/UMEC. Patients with comorbid asthma, heart failure, or pneumonia were excluded. A 1:1 propensity-score matching (PSM) analysis was performed to balance covariates such as age, gender, smoking status, and baseline lung function to minimize confounding and bias. Post-matching, both had 16,052 patients. Ultimately, 23,331 patients (FF/VI/UMEC: 11,234, GLY/BUD/FOR: 12,097) with a mean age of 67.4 ± 10.1 years and 55.3% males were included. Results: Among groups, 10.4% of patients on FF/VI/UMEC experienced COPD exacerbations compared to 6.7% on GLY/BUD/FOR (Risk Ratio: 1.55, 95% CI: 1.42-1.69, p &lt; 0.001). Kaplan-Meier analysis showed a lower survival probability in the FF/VI/UMEC group (77.7% vs. 83.9%, p &lt; 0.001). For acute respiratory failure, 3.5% of patients on FF/VI/UMEC experienced this outcome compared to 2.8% on GLY/BUD/FOR (Risk Ratio: 1.28, 95% CI: 1.12-1.45, p = 0.003). Conclusion: Our study suggests that FF/VI/UMEC demonstrated an increased risk of COPD exacerbations and acute hypoxic respiratory failure compared to the group receiving GLY/BUD/FOR. This indicates that GLY/BUD/FOR may provide enhanced protective benefits in patients with moderate to severe COPD, improving disease management and minimizing healthcare resource utilization. Further studies are warranted to explore the long-term benefits and potential mechanisms underlying the observed differences.

Abstract Background: Pulmonary rehabilitation (PR) is a comprehensive intervention and essential component for integrated care with patients with chronic respiratory diseases, especially Chronic Obstructive Pulmonary Disease (COPD). American Thoracic Society (ATS) strongly recommends PR for patients with COPD after exacerbation. PR has been shown to reduce mortality, improve quality of life, and decrease hospital readmissions in patients with COPD. Despite these benefits, access to PR remains unevenly distributed, particularly among racial and ethnic minorities. This study explores racial and ethnic disparities in PR utilization among COPD patients with a history of exacerbations. Methods: Utilizing data from the TrinetX Research Network, we examined two cohorts of COPD patients. Cohort 1 (N=493) consisted of patients with COPD and prior exacerbations who received PR, while Cohort 2 (N=457,573) included similar patients who did not receive PR. Demographics, specifically, race and ethnicity, were statistically analyzed to assess the presence and significance of disparities, using chi-square tests and standardized mean differences (SMD) to provide a comparative framework.Results:493 patients were in the PR group and 457,573 patients in the non-PR group, comprising 458,066 patients across both cohorts. Among the 493 patients in the PR cohort, the largest group was categorized as Other Race (192 patients, 38.9%, p &lt; 0.001, SMD = 1.040), followed by White patients (154 patients, 31.2%, p &lt; 0.001, SMD = 0.899). Black or African American and Asian patients were both minimally represented, with 10 patients each (2.0%, p &lt; 0.001, SMD = 0.319 and SMD = 0.034, respectively), while 137 patients (27.8%, p &lt; 0.001, SMD = 0.349) were of Unknown Race. In contrast, the non-PR cohort, comprising 470,239 patients, had a substantially higher proportion of White patients (330,409 patients, 72.2%) and a significantly greater representation of Black or African American individuals (42,573 patients, 9.3%, p &lt; 0.001, SMD = 0.319) and Hispanic or Latino individuals (13,709 patients, 3.0%, p &lt; 0.001, SMD = 0.249) compared to the PR cohort. Conclusion: This study highlights significant disparities in the utilization of PR among COPD patients, with underrepresented racial and ethnic groups demonstrating lower access to this intervention. These findings highlight the need for targeted strategies to address potential barriers to PR, promoting equitable access across diverse populations. Further investigation into structural and socioeconomic factors influencing PR access will be crucial to fostering inclusive care and reducing healthcare disparities in COPD management.

Abstract Introduction: Obesity's increasing prevalence significantly impacts Intensive Care Unit (ICU) patient outcomes, especially for those requiring prolonged mechanical ventilation. This study investigates the effect of Body Mass Index (BMI) on mortality and complications—such as acute respiratory distress syndrome (ARDS), pulmonary embolism (PE), and deep vein thrombosis (DVT)—in ICU patients intubated for over 96 hours. Methods: We conducted a retrospective cohort study using the TriNetX database to identify patient populations with relevant ICD codes. Patients who had received anticoagulation and had been on mechanical ventilation for more than 96 hours were included. Cohort 1 consisted of patients with a BMI of 30-44.9 kg/m² (n = 70,379), and Cohort 2 included patients with a BMI of 18.5-29.9 kg/m² (n = 111,054). Both cohorts were matched using propensity score matching (PSM), resulting in balanced groups of 47,233 patients. The mean age was 64.3 ± 15.1 years in Cohort 1 and 64.5 ± 16.5 years in Cohort 2, with a male predominance of 57.9% in both cohorts after matching. Outcomes (mortality, PE, DVT, and ARDS) were identified using ICD-10 codes and analyzed on Days 14, 30, and 90. Results: Higher BMI was associated with increased all-cause mortality across all measured time points. By Day 14, mortality was 23.0% in Cohort 1 versus 19.2% in Cohort 2 (RiskRatio [RR]: 1.196; 95% CI: 1.166-1.226). By Day 90, mortality reached 37.6% in Cohort 1 compared to 32.6% in Cohort 2 (RR: 1.151; 95% CI: 1.132-1.171). Additionally, the risk of developing ARDS was higher in Cohort 1, with statistically significant risk ratios observed on Day 14 (RR: 1.117; 95% CI: 1.020-1.222) and Day 30 (RR: 1.094; 95%CI: 1.010-1.186). PE risk in Cohort 1 significantly increased by Day 30 (RR: 1.119; 95% CI: 1.008-1.243), while DVT risk was also elevated in Cohort 1 at both Day 14 (RR:1.140; 95% CI: 1.037-1.253) and Day 30 (RR: 1.129; 95% CI: 1.040-1.224). Conclusion: Higher BMI in mechanically ventilated ICU patients intubated for more than 96 hours is associated with increased mortality and a higher incidence of complications, including ARDS, PE, and DVT. This study contributes to our understanding of BMI's impact on ICU outcomes, highlighting critical areas for improved clinical management in this population and the need for targeted interventions in obese ICU patients, such as optimized respiratory support and monitoring for thromboemboliccomplications.

e16531 Background: Hypoxia-inducible Factor-2α (HIF-2α) is a transcription factor that accumulates in clear cell renal cell carcinoma (ccRCC) and is responsible for genes involved in oncogenesis. Belzutifan is a HIF-2α inhibitor that has shown promising anti-tumor effects in patients with ccRCC. Our objective is to summarize the available literature on the safety and efficacy profile of the drug. Methods: An electronic search was conducted on PubMed, Embase, and Cochrane from inception till January 31st, 2024. We identified patients aged ≥ 18 years with ccRCC who received Belzutifan. We extracted data on objective response rate, complete response rate, any grade adverse effect (AE) and grade ≥3 AE. Data was analyzed using R (v.4.3) and reported as proportions with respective 95% confidence intervals (CI) on forest plots. Results: Three studies (n=168 patients) were identified that reported the use of Belzutifan in ccRCC. Our analysis showed that pooled proportion of objective response rate and complete response rate was 35% (95% CI: 24% – 47%) and 1% (95% CI: 0% – 5%) respectively. Pooled proportion of patients experiencing any grade AE and grade ≥3 AE was 98% (95% CI: 95% – 99%) and 49% (95% CI: 29% – 69%) respectively. Conclusions: Belzutifan is a novel drug that inhibits HIF-2α which in turn results in anti-tumor effects of the drug against ccRCC. The drug has an acceptable safety and efficacy profile from limited data but more studies are needed to establish a complete picture of drug’s adverse effects and clinical benefits. Pooled proportion of patients developing (A) Objective Response, (B) Complete response (C) Any adverse effect and (D) Grade ≥3 adverse effects. [Table: see text]