{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T19:46:27Z","timestamp":1775677587352,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,8,3]],"date-time":"2018-08-03T00:00:00Z","timestamp":1533254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004336","name":"Novartis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>Combination long\u2010acting \u03b2<jats:sub>2<\/jats:sub>\u2010agonist\/long\u2010acting muscarinic antagonist (LABA\/LAMA) has demonstrated superior clinical outcomes over LABA\/inhaled corticosteroid (ICS) in chronic obstructive pulmonary disease (COPD) patients; however, data from blinded randomized controlled trials on direct switching from LABA\/ICS to LABA\/LAMA are lacking. FLASH (Assessment of switching salmeterol\/<jats:italic>F<\/jats:italic>luticasone to indacatero<jats:italic>L<\/jats:italic>\/glycopyrronium in <jats:italic>A S<\/jats:italic>ymptomatic COPD patient co<jats:italic>H<\/jats:italic>ort) investigated if direct switch, without a washout period, from salmeterol\/fluticasone (SFC) to indacaterol\/glycopyrronium (IND\/GLY) in COPD patients improves lung function and is well tolerated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this 12\u2010week, multicentre, double\u2010blind study, patients with moderate\u2010to\u2010severe COPD and up to one exacerbation in previous year, receiving SFC for \u22653\u2009months, were randomized to continue SFC 50\/500\u2009\u03bcg twice daily (bd) or switch to IND\/GLY 110\/50\u2009\u03bcg once daily (od). Primary endpoint was pre\u2010dose trough forced expiratory volume in 1\u2009s (FEV<jats:sub>1<\/jats:sub>) at Week 12.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 502 patients were randomized (1:1) to IND\/GLY or SFC. Patients switched to IND\/GLY demonstrated superior lung function (pre\u2010dose trough FEV<jats:sub>1<\/jats:sub>) versus SFC at Week 12 (treatment difference (\u0394)\u2009=\u200945\u2009mL; <jats:italic>P<\/jats:italic>\u2009=\u20090.028). IND\/GLY provided significant improvements in pre\u2010dose trough forced vital capacity (FVC; \u0394\u2009=\u2009102\u2009mL; <jats:italic>P<\/jats:italic>\u2009=\u20090.002) and numerical improvements in transition dyspnoea index (TDI; \u0394\u2009=\u20090.46; <jats:italic>P<\/jats:italic>\u2009=\u20090.063). Rescue medication use and COPD assessment test (CAT) scores were comparable between groups. Both treatments had similar safety profiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>FLASH demonstrated that a direct switch to IND\/GLY from SFC improved pre\u2010dose FEV<jats:sub>1<\/jats:sub> and FVC in COPD patients with up to one exacerbation in the previous year. No new safety signals were identified.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.13374","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T05:15:59Z","timestamp":1533618959000},"page":"1152-1159","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Efficacy and safety of the direct switch to indacaterol\/glycopyrronium from salmeterol\/fluticasone in non\u2010frequently exacerbating COPD patients: The FLASH randomized controlled trial"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3265-0131","authenticated-orcid":false,"given":"Peter A.","family":"Frith","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Southern Adelaide Local Health Network  Adelaide SA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samiha","family":"Ashmawi","sequence":"additional","affiliation":[{"name":"Ain Shams University  Cairo Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srikanth","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Sri Bala Medical Centre and Hospital  Coimbatore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alev","family":"Gurgun","sequence":"additional","affiliation":[{"name":"Ege University Medical Faculty  \u0130zmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sashka","family":"Hristoskova","sequence":"additional","affiliation":[{"name":"Novartis Pharma AG  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Pilipovic","sequence":"additional","affiliation":[{"name":"Novartis Pharma AG  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Marie","family":"Hamann","sequence":"additional","affiliation":[{"name":"DATAMAP GmbH  Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur","family":"Backer","sequence":"additional","affiliation":[{"name":"Novartis Pharma AG  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petter","family":"Olsson","sequence":"additional","affiliation":[{"name":"Novartis Sverige AB  Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Kostikas","sequence":"additional","affiliation":[{"name":"Novartis Pharma AG  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina V.","family":"Diaz","sequence":"additional","affiliation":[{"name":"Lung Center of the Philippines  Quezon City Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the FLASH Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,8,3]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"GOLD. 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