Chest
Original Research: COPDComparative Effectiveness and Safety of LABA-LAMA vs LABA-ICS Treatment of COPD in Real-World Clinical Practice
Section snippets
Data Source
This study was conducted using the Clinical Practice Research Datalink (CPRD), a primary care database from the United Kingdom that contains primary care medical records for over 10 million people enrolled from over 600 practices. Trained participating general practitioners record medical information, including demographic data, lifestyle factors, and medical diagnoses, using the Read classification. Prescriptions are automatically transcribed, using the UK Prescription Pricing Authority
Results
The base cohort included 56,460 patients with a diagnosis of COPD and a prescription for LABA, LAMA, or ICS from January 1, 2002 to December 31, 2015, after excluding patients with a diagnosis of asthma and less than 55 years of age (Fig 1). There were 2,066 initiators of LABA-LAMA on the same date at some point during follow-up. After computing time-conditional propensity score, 1,977 initiators of LABA-LAMA were matched to 1,977 initiators of LABA-ICS. The baseline characteristics of these
Discussion
In this observational study in the real-world setting of COPD treatment, we found that patients treated with a LABA and a LAMA, both as initial treatment or adding one to the other, have a similar incidence of exacerbations as those treated with a LABA and an ICS, over the first year of use. There was a trend for a higher incidence of exacerbation with LABA-LAMA in patients with a > 6% blood eosinophil count. However, the incidence of pneumonia was lower with the LABA-LAMA treatment. This is
Acknowledgments
Author contributions: P. E. participated in study design, data interpretation, and writing of the manuscript. S. D’A. participated in data analysis and writing of the manuscript. S. S. participated in data acquisition, study design, data interpretation, and writing of the manuscript, and acts as guarantor of this entire manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: S. S. has received research grants from Boehringer Ingelheim and Novartis and
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2021, ChestCitation Excerpt :In contrary to our findings, the Informing the Pathway of COPD Treatment Trial reported a lower rate of moderate to severe exacerbation in the vilanterol plus fluticasone furoate group than in the VI/UMEC group (1.07 vs 1.21 exacerbations per year)4; however, this trial included patients with asthma diagnosis before randomization, and the withdrawal of ICS at baseline was suspected to confound the reported findings.13 Additionally, two large cohort studies reported a comparable class effect of LABA/LAMA vs LABA/ICS therapies regarding the annual rate of exacerbations in patients with COPD, but without examining the comparative effects of different dual agents.12,14 Our overall findings, along with our additional analysis, may indicate an intraclass difference among the individual dual agents in LABA/ICS combinations regarding the effectiveness outcome and pneumonia risk, which might be attributed to physicochemical, pharmacokinetic, and pharmacodynamic properties of different ICS molecules, although varying effects of different LABA molecules could not be ruled out completely.22,39-42
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