LAMA/LABA therapy reduced risk for COPD exacerbation, pneumonia hospitalization
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Key takeaways:
- Inhalers with a long-acting muscarinic antagonist and a long-acting beta agonist (LABA) resulted in “better outcomes” than an inhaled corticosteroid plus LABA.
- This result was sustained in subgroup analysis.
A long-acting muscarinic antagonist plus long-acting beta agonist (LABA) was linked to fewer COPD exacerbations and pneumonia hospitalizations vs. an inhaled corticosteroid and LABA, according to results published in JAMA Internal Medicine.
“We found that long-acting muscarinic antagonist (LAMA)-LABA therapy was associated with a lower risk of COPD exacerbations and a lower risk of pneumonia hospitalizations than inhaled corticosteroid (ICS)-LABA therapy,” William B. Feldman, MD, DPhil, MPH, associate physician in the division of pulmonary and critical care medicine at Brigham and Women’s hospital and instructor at Harvard Medical School, told Healio.
In a cohort study, Feldman and colleagues analyzed 137,833 adults (mean age, 70.2 years; 50.4% women) from Optum’s Clinformatics Data Mart with COPD who were newly prescribed either LAMA-LABA therapy (n = 30,829; 47.3% women) or ICS-LABA therapy (n = 107,004; 51.3% women) to see which combination inhaler is linked to a lower rate of first moderate/severe COPD exacerbations and hospitalizations for pneumonia.
LAMA-LABA inhaler combinations used by patients in this study included aclidinium-formoterol (Duaklir Pressair, Covis), glycopyrronium-formoterol (Bevespi Aerosphere, AstraZeneca), glycopyrronium-indacaterol (Utibron Neohaler, Novartis), tiotropium olodaterol (Stiolto Respimat, Boehringer Ingelheim) and umeclidinium-vilanterol (Anoro Ellipta, GSK).
Researchers observed the following combinations for ICS-LABA therapy: budesonide-formoterol (Symbicort, AstraZeneca), fluticasone-salmeterol (Advair-Diskus, GSK), fluticasone-vilanterol (Breo Ellipta, GSK) and mometasone-formoterol (Dulera, Organon).
In order to make sure that both groups had similar baseline variables (age, sex, number of moderate and severe COPD exacerbations, Global Initiative for Obstructive Lung Disease stage, etc), researchers propensity score matched patients using estimates from logistic regression analysis and ended up with 30,216 matched pairs. They then found the risk for both outcomes in each group through Cox proportional hazards models.
Evaluating the rate of first moderate/severe COPD exacerbations, those receiving a form of LAMA-LABA treatment experienced this event less often than those receiving a form of ICS-LABA (HR = 0.92; 95% CI, 0.89-0.96).
The risk for the first hospitalization with pneumonia was also lower among adults in the LAMA-LABA group vs. ICS-LABA group (HR = 0.8; 95% CI, 0.75-0.86), according to researchers.
Similar to the findings from the above analyses assessing the rate of first events, researchers found decreased overall incidence rates of exacerbations (incidence rate ratio [IRR] = 0.95; 95% CI, 0.93-0.98) and pneumonia hospitalizations (IRR = 0.83; 95% CI, 0.78-0.88) with LAMA-LABA therapy.
Researchers continued to see more benefits among those using a form of LAMA-LABA vs. ICS-LABA therapy when evaluating exacerbations by severity, with fewer first moderate exacerbations (HR = 0.93; 95% CI, 0.9-0.97), overall moderate exacerbations (IRR = 0.96; 95% CI, 0.93-1) and first severe exacerbations (HR = 0.85; 95% CI, 0.77-0.94).
Further, researchers observed better clinical outcomes with LAMA-LABA in subgroup analyses and when comparing it to the individual ICS-LABA combination inhalers.
“ICS-LABAs remain widely prescribed for COPD in the U.S.,” Feldman told Healio. “This study underscores the need for clinicians to exercise more caution when prescribing this combination in COPD.”
For more information:
William B. Feldman, MD, DPhil, MPH, can be reached at wbfeldman@bwh.harvard.edu.