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Long-acting bronchodilator combination may be preferred for preventing COPD exacerbations

Among patients with COPD, combination treatment with a long-acting beta agonist plus a long-acting muscarinic antagonist was as effective as combination therapy with a LABA and an inhaled corticosteroid for preventing exacerbations while also being associated with fewer hospitalizations for severe pneumonia, new data published in CHEST indicate.

The researchers conducted an observational real-world study using data from 2002 to 2015 on patients aged 55 years and older with COPD in the United Kingdom’s Clinical Practice Research Datalink. Using time-conditional high-dimensional propensity scores, they matched patients initiating a LABA plus LAMA (n = 1,977; mean treatment duration, 3.3 months) with patients initiating a LABA plus inhaled corticosteroids (n = 1,977; mean treatment duration, 2.8 months) on the same day.

Patients were monitored for 1 year for COPD exacerbations and severe pneumonia.

For the LABA plus LAMA group, the incidence rate of first moderate or severe exacerbation was 76.3 per 100 per year vs. 74.1 per 100 per year for the LABA plus inhaled corticosteroid group. For first moderate or severe exacerbation, the adjusted HR was 1.04 for the LABA plus LAMA group compared with the LABA plus inhaled corticosteroid group (95% CI, 0.9-1.2), according to the as-treated analysis. For severe exacerbations, the adjusted HR was 0.94 (95% CI, 0.65-1.36), and the cumulative incidence of a first moderate or severe exacerbation during 1 year was similar between the two groups.

In the as-treated analysis, adjusted hazard ratios associated with LABA plus LAMA vs. LABA plus inhaled corticosteroid were 1.07 (95% CI, 0.92-1.25) for moderate to severe exacerbations and 0.85 (95% CI, 0.55-1.33) for severe exacerbations.

For first pneumonia hospitalization, the incidence rate was 5.1 per 100 per year in the LABA plus LAMA group vs. 7.7 in the LABA plus inhaled corticosteroid group, translating to an adjusted HR of 0.66 (95% CI, 0.41-1.05) for first severe pneumonia event with LABA plus LAMA vs. LABA plus inhaled corticosteroids.

Additionally, this finding was more pronounced in the on-treatment analysis using any current LABA plus LAMA and LABA plus inhaled corticosteroid exposures during the entire 1-year follow-up (HR = 0.66; 95% CI, 0.48-0.92).

Results were similar in the intent-to-treat and other stratified analyses.

The researchers noted that the study had several limitations, such as basing exposure measures on written vs. dispensed prescriptions; shortened continuous combination treatment durations due to discontinuation of medications or addition of another agent; the small fraction of patients initiating LABA plus LAMA at some point during the study period; and the potential inclusion of patients with asthma due to defining COPD based on physician diagnosis.

The results of this real-world study demonstrate that LABA plus LAMA inhalers are likely comparable to LABA plus inhaled corticosteroid inhalers in for prevention of COPD exacerbations, according to the researchers.

“However, a LABA-LAMA combination may be preferred because it is associated with fewer severe pneumonias,” they wrote. – by Melissa Foster

Disclosures: This research was funded in part by grants from the Canadian Institutes of Health Research, the Canada Foundation for Innovation and Boehringer Ingelheim. One author reports he has received research grants from Boehringer Ingelheim and Novartis, and he has participated in advisory board meetings or as a speaker for AstraZeneca, Boehringer Ingelheim and Novartis. All other authors report no relevant financial disclosures.