Breztri Aerosphere significantly reduced rate of moderate or severe COPD exacerbations in Phase III ETHOS trial (2023)

24 June 2020 19:00 BST

Trial results published in New England Journal of Medicine

Full results from the positive Phase III ETHOS trial showed AstraZeneca’s triple-combination therapy Breztri Aerosphere (budesonide/glycopyrronium/formoterol fumarate) demonstrated a statistically significant reduction in the rate of moderate or severe exacerbations compared with two dual-combination therapies in patients with moderate to very severe chronic obstructive pulmonary disease (COPD).1

Compared with Bevespi Aerosphere (glycopyrronium/formoterol fumarate), Breztri Aerosphere achieved a 24% reduction (p<0.001) in exacerbations. Breztri Aerosphere achieved a 13% reduction (p=0.003) compared with PT009 (budesonide/formoterol fumarate). The dual-combination therapies used as comparators in the trial represent recommended therapeutic classes for the treatment of COPD.2

In a key secondary endpoint, Breztri Aerosphere showed a 46% reduction in the risk of all-cause mortality compared with Bevespi Aerosphere (unadjusted p=0.01).3

The results were published in the New England Journal of Medicine1 and simultaneously presented at the American Thoracic Society virtual Scientific Symposium, Clinical Trial Results in Pulmonary Medicine.3 AstraZeneca will continue to review these data with health authorities.

(Video) Triple Tx Effective in COPD with Low Exacerbation Risk - Medpage Today

Klaus Rabe, Professor of Pulmonary Medicine at the University of Kiel, Director of the Department of Pneumology at Clinic Grosshansdorf, Germany, and Lead Investigator of the ETHOS trial, said: “The Phase III ETHOS trial results are important and demonstrate the benefit of Breztri Aerosphere in reducing the rate of exacerbations in this progressive disease. The findings also show that reducing risk of all-cause mortality is achievable and could transform treatment goals in chronic obstructive pulmonary disease.”

Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, said: “Chronic obstructive pulmonary disease is the third leading cause of death worldwide and exacerbations can contribute to an increase in mortality in these patients. The results of the Phase III ETHOS trial support the strong clinical profile of Breztri Aerosphere in reducing exacerbation rates compared with dual-combination therapies. We are excited to have the data on all-cause mortality, which is a key consideration for COPD management.”

The safety and tolerability of Breztri Aerosphere were consistent with the known profiles of the dual comparators.In the trial, the most frequently reported adverse events were nasopharyngitis, COPD and upper respiratory tract infection. The incidence of confirmed pneumonia was 4.2% with Breztri Aerosphere, 2.3% with Bevespi Aerosphere and 4.5% with PT009.

These results are based on Breztri Aerosphere at the standard dose of budesonide (budesonide/glycopyrronium/formoterol fumarate 320/14.4/9.6mcg), an inhaled corticosteroid (ICS). In the trial, Breztri Aerosphereat half the dose of budesonide (budesonide/glycopyrronium/formoterol fumarate 160/14.4/9.6mcg) also demonstrated a statistically significant reduction in the rate of moderate or severe exacerbations compared with Bevespi Aerosphere(glycopyrronium/formoterol fumarate 14.4/9.6mcg) and PT009 (budesonide/formoterol fumarate 320/9.6mcg).1

Breztri Aerosphere is approved in Japan and China for patients with COPD. It is under regulatory review in the US and EU.


COPD is a progressive disease which can cause obstruction of airflow in the lungs resulting in debilitating bouts of breathlessness.2 It affects an estimated 384 million people4 and is the third leading cause of death globally.5 Improving lung function, reducing exacerbations and managing daily symptoms such as breathlessness are important treatment goals in the management of COPD.2 Even a single COPD exacerbation may be associated with a significant increase in the rate of decline in lung function,6 a significant deterioration in quality of life,7 and can significantly reduce life expectancy and increase the risk of mortality.8,9

ETHOS and the ATHENA clinical trial programme

ETHOS is a randomised, double-blinded, multi-centre, parallel-group, 52-week trial to assess the efficacy and safety of Breztri Aerosphere in symptomatic patients with moderate to very severe COPD and a history of exacerbation(s) in the previous year. Outcomes in the ETHOS trial included, as a primary endpoint, the rate of moderate or severe exacerbations.

(Video) New ETHOS Findings for ATS 2020

Bevespi Aerosphere is a fixed-dose dual bronchodilator in a pressurised metered-dose inhaler (pMDI), combining glycopyrronium, a long-acting muscarinic antagonist (LAMA), and formoterol fumarate, a long-acting beta2-agonist (LABA). PT009 is a single inhaler, fixed-dose dual-combination therapy of budesonide, an ICS, and formoterol fumarate, a LABA. It was developed as a relevant comparator in clinical trials for Breztri Aerosphere.

ETHOS involved more than 8,500 patients who had experienced ≥1 moderate/severe exacerbation in the previous year and were receiving at least two inhaled maintenance treatments at entry into the trial.

ETHOS is part of AstraZeneca’s ATHENA Phase III clinical trial programme for Breztri Aerosphere, which included more than 15,500 patients globally across 11 trials. The results of the earlier pivotal Phase III KRONOS trial were published in Lancet Respiratory Medicine.10

ETHOS primary and key secondary endpoints

Breztri Aerosphere

Breztri Aerosphere (budesonide/glycopyrronium/formoterol fumarate) is a single-inhaler, fixed dose triple-combination of budesonide, an ICS, with glycopyrronium, a LAMA, and formoterol fumarate, a LABA.

Under the terms of the agreement to acquire Pearl Therapeutics Inc., AstraZeneca anticipates making a $150m milestone payment upon US regulatory approval of Breztri Aerosphere for COPD. This payment would be the final development and regulatory milestone under that agreement.

(Video) Triple Therapy in COPD: IMPACT and FULFIL

AstraZeneca in Respiratory & Immunology

Respiratory & Immunology is one of AstraZeneca’s three therapy areas and is a key growth driver for the Company.

AstraZeneca is an established leader in respiratory care, and its inhaled and biologic medicines reached more than 53 million patients in 2019. Building on a 50-year heritage, the Company aims to transform the treatment of asthma and COPD by focusing on earlier biology-led treatment, eliminating preventable asthma attacks, and removing COPD as a top-three leading cause of death. The Company’s early respiratory research is focused on emerging science involving immune mechanisms, lung damage and abnormal cell-repair processes in disease and neuronal dysfunction.

With common pathways and underlying disease drivers across respiratory and immunology, AstraZeneca is following the science from chronic lung diseases to immunology-driven disease areas. The Company’s growing presence in immunology is focused on five mid- to late-stage franchises with multi-disease potential, in areas including rheumatology (including Systemic Lupus Erythematosus), dermatology, gastroenterology, and systemic eosinophilic-driven diseases. AstraZeneca’s ambition in Respiratory & Immunology is to achieve disease modification and durable remission for millions of patients worldwide.


AstraZeneca (LSE/STO/NYSE: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialisation of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, Cardiovascular, Renal and Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit and follow the Company on Twitter @AstraZeneca.


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1. Rabe KF, Martinez FJ, Ferguson GT, et al. Inhaled Triple Therapy at Two Glucocorticoid Doses in Moderate-to-Very Severe COPD. NEJM 2020; published on June 24, 2020, at DOI: 10.1056/NEJMoa191604.

2. GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. [Online]. Available at: [Last accessed: June 2020].

3. Rabe KF. Inhaled Triple Therapy at Two Glucocorticoid Doses in Moderate-to-Very Severe COPD: The ETHOS Study. ATS Scientific Symposium. Breaking News: Clinical Trial Results in Pulmonary Medicine. June 24, 2020.

4. Adeloye D, Chua S, Lee C,et al. Global Health Epidemiology Reference Group (GHERG). Global and regional estimates of COPD prevalence: Systematic review and meta-analysis.J Glob Health. 2015; 5 (2): 020415.

5. Quaderi SA, Hurst JR. The unmet global burden of COPD.Glob Health Epidemiol Genom. 2018; 3: e4. Published 2018 Apr 6. doi:10.1017/gheg.2018.1

6. Halpin DMG, Decramer M, Celli BR, et al. Effect of a single exacerbation on decline in lung function in COPD. Respiratory Medicine 2017; 128: 85-91.

7. Roche N, Wedzicha JA, Patalano F, et al. COPD exacerbations significantly impact quality of life as measured by SGRQ-C total score: results from the FLAME study.Eur Resp J.2017; 50 (Suppl 61): OA1487

(Video) Characteristics That Help Diagnose COPD

8. Ho TW, Tsai YJ, Ruan SY, et al. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12): e114866.

9. Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012; 67 (11): 957-63.

10. Ferguson GT, Rabe KF, Martinez FJ, et al. Triple combination of budesonide/glycopyrrolate /formoterol fumarate using co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, randomised controlled trial. Lancet Respir Med. 2018; 6: 747–758.

(Video) Episode 40 - Breztri, Xywav, & Tecartus


Breztri Aerosphere significantly reduced rate of moderate or severe COPD exacerbations in Phase III ETHOS trial? ›

Full results from the positive Phase III ETHOS trial showed AstraZeneca's triple-combination therapy Breztri Aerosphere (budesonide/glycopyrronium/formoterol

Formoterol, also known as eformoterol, is a long-acting β2 agonist (LABA) used as a bronchodilator in the management of asthma and chronic obstructive pulmonary disease (COPD). › wiki › Formoterol
fumarate) demonstrated a statistically significant reduction in the rate of moderate or severe exacerbations compared with two dual-combination therapies in ...

Is BREZTRI a good inhaler for COPD? ›

BREZTRI is used long term for the treatment of COPD.

BREZTRI was proven to improve lung function starting within 5 minutes. *Results may vary. †BREZTRI is not used to relieve sudden breathing problems and will not replace a rescue inhaler.

What is the ethos trial? ›

The ETHOS trial assessed two different doses of an inhaled glucocorticoid in fixed-dose triple therapy for COPD.

Can BREZTRI make breathing worse? ›

If you have sudden breathing problems immediately after inhaling your medicine, stop taking BREZTRI AEROSPHERE and call your healthcare provider right away.

How long does it take for BREZTRI to work? ›

Breztri Aerosphere begins working as soon as you take a dose. But you may not notice your condition getting better right away. Breztri Aerosphere is meant to work over time to help stop COPD symptoms from becoming worse.

Why is BREZTRI so expensive? ›

Breztri Aerosphere only comes as a brand-name drug. It's not currently available in a generic version. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

What is the very best inhaler for COPD? ›

TRELEGY is the only FDA-approved once-daily medicine that combines 3 long-acting medicines in 1 inhaler. TRELEGY is used to improve symptoms of COPD. TRELEGY's 3 medicines are also proven to significantly reduce flare-ups.

What are the 4 types of ethos? ›

There are four main characteristics of ethos:
  • Trustworthiness and respect.
  • Similarity to the audience.
  • Authority.
  • Expertise and reputation/history.
Apr 11, 2018

What are 3 techniques for ethos? ›

Ethos can be promoted by choosing appropriate language & vocabulary (dependent on the audience and topic), by making yourself look honest, by paying attention to your movements and the way you dress (for your digital presence pay attention to design details, functionality, content, etc.)

What meds should not be taken with BREZTRI? ›

Caution should be exercised when considering the coadministration of BREZTRI AEROSPHERE with long-term ketoconazole, and other known strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin) because adverse effects related to ...

How long should you take BREZTRI? ›

BREZTRI is used long term as 2 inhalations 2 times each day (2 puffs in the morning and 2 puffs in the evening) to improve symptoms of COPD for better breathing*,† and to reduce the number of flare-ups*,† (the worsening of your COPD symptoms for several days).

What is the warning of BREZTRI? ›

Tell your doctor right away if you have any serious side effects, including: white patches on tongue/in mouth, signs of infection (such as sore throat that doesn't go away, fever), difficult/painful urination, muscle cramps/weakness, increased thirst/urination, bone pain, mental/mood changes (such as nervousness), ...

How many puffs of BREZTRI should I take? ›

BREZTRI is Administered as 2 Inhalations, Twice. Daily:

Patients should not take more than two inhalations twice daily. After inhalation, the patient should rinse their mouth with water without swallowing.

Can BREZTRI cause weight gain? ›

Does Breztri Aerosphere inhaler cause weight gain? No, weight gain is not a side effect reported in Breztri Aerosphere's clinical trials. Budesonide, a corticosteroid drug in Breztri Aerosphere, can weaken your adrenal function. This may cause weight loss.

Can BREZTRI make you jittery? ›

If you take too much Breztri Aerosphere, call your healthcare provider or go to the nearest hospital emergency room right away if you have any unusual symptoms, such as worsening shortness of breath, chest pain, increased heart rate, or shakiness.

How effective is the BREZTRI inhaler? ›

ETHOS: In Study 1 (52 weeks), BREZTRI significantly reduced the annual rate of moderate or severe COPD exacerbations by 24% vs LAMA/LABA (rate ratio=0.76; P<0.0001) and by 13% vs ICS/LABA (rate ratio=0.87; P=0.0027).

Which is better BREZTRI or Trelegy? ›

The only condition both Breztri Aerosphere and Trelegy Ellipta are used to treat is COPD. These drugs haven't been directly compared in clinical studies. But studies have found both Breztri Aerosphere and Trelegy Ellipta to be effective for treating COPD. Both drugs are triple-therapy combination inhalers.

Which is better Symbicort or BREZTRI? ›

Breztri Aerosphere has an average rating of 6.4 out of 10 from a total of 52 ratings on 55% of reviewers reported a positive effect, while 24% reported a negative effect. Symbicort has an average rating of 6.5 out of 10 from a total of 217 ratings on


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