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Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study.
J Intern Med. 2013 Jun; 273(6):584-94.JI

Abstract

OBJECTIVES

Combinations of inhaled corticosteroids (ICSs) and long-acting β2 -agonists (LABAs) are recommended for patients with moderate and severe chronic obstructive pulmonary disease (COPD). However, it is not known whether different fixed combinations are equally effective. The aim of this study was to investigate exacerbation rates in primary care patients with COPD treated with budesonide/formoterol compared with fluticasone/salmeterol.

METHODS

Patients with physician-diagnosed COPD and a record of postdiagnosis treatment with a fixed combination of budesonide/formoterol or fluticasone/salmeterol were included. Data from primary care medical records were linked to those from Swedish national hospital, drug and cause of death registers. Pairwise (1 : 1) propensity score matching was carried out at the index date (first prescription) by prescribed fixed ICS/LABA combination. Exacerbations were defined as hospitalizations, emergency visits and collection of oral steroids or antibiotics for COPD. Yearly event rates were compared using Poisson regression.

RESULTS

Matching of 9893 patients (7155 budesonide/formoterol and 2738 fluticasone/salmeterol) yielded two cohorts of 2734 patients, comprising 19 170 patient-years. The exacerbation rates were 0.80 and 1.09 per patient-year in the budesonide/formoterol and fluticasone/salmeterol groups, respectively (difference of 26.6%; P < 0.0001); yearly rates for COPD-related hospitalizations were 0.15 and 0.21, respectively (difference of 29.1%; P < 0.0001). All other healthcare outcomes were also significantly reduced with budesonide/formoterol versus fluticasone/salmeterol.

CONCLUSIONS

Long-term treatment with fixed combination budesonide/formoterol was associated with fewer healthcare utilization-defined exacerbations than fluticasone/salmeterol in patients with moderate and severe COPD.

Authors+Show Affiliations

Unit of Lung and Allergy Research, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. kjell.larsson@ki.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23495860

Citation

Larsson, K, et al. "Combination of Budesonide/formoterol More Effective Than Fluticasone/salmeterol in Preventing Exacerbations in Chronic Obstructive Pulmonary Disease: the PATHOS Study." Journal of Internal Medicine, vol. 273, no. 6, 2013, pp. 584-94.
Larsson K, Janson C, Lisspers K, et al. Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study. J Intern Med. 2013;273(6):584-94.
Larsson, K., Janson, C., Lisspers, K., Jørgensen, L., Stratelis, G., Telg, G., Ställberg, B., & Johansson, G. (2013). Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study. Journal of Internal Medicine, 273(6), 584-94. https://doi.org/10.1111/joim.12067
Larsson K, et al. Combination of Budesonide/formoterol More Effective Than Fluticasone/salmeterol in Preventing Exacerbations in Chronic Obstructive Pulmonary Disease: the PATHOS Study. J Intern Med. 2013;273(6):584-94. PubMed PMID: 23495860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study. AU - Larsson,K, AU - Janson,C, AU - Lisspers,K, AU - Jørgensen,L, AU - Stratelis,G, AU - Telg,G, AU - Ställberg,B, AU - Johansson,G, Y1 - 2013/04/01/ PY - 2013/3/19/entrez PY - 2013/3/19/pubmed PY - 2013/7/13/medline SP - 584 EP - 94 JF - Journal of internal medicine JO - J Intern Med VL - 273 IS - 6 N2 - OBJECTIVES: Combinations of inhaled corticosteroids (ICSs) and long-acting β2 -agonists (LABAs) are recommended for patients with moderate and severe chronic obstructive pulmonary disease (COPD). However, it is not known whether different fixed combinations are equally effective. The aim of this study was to investigate exacerbation rates in primary care patients with COPD treated with budesonide/formoterol compared with fluticasone/salmeterol. METHODS: Patients with physician-diagnosed COPD and a record of postdiagnosis treatment with a fixed combination of budesonide/formoterol or fluticasone/salmeterol were included. Data from primary care medical records were linked to those from Swedish national hospital, drug and cause of death registers. Pairwise (1 : 1) propensity score matching was carried out at the index date (first prescription) by prescribed fixed ICS/LABA combination. Exacerbations were defined as hospitalizations, emergency visits and collection of oral steroids or antibiotics for COPD. Yearly event rates were compared using Poisson regression. RESULTS: Matching of 9893 patients (7155 budesonide/formoterol and 2738 fluticasone/salmeterol) yielded two cohorts of 2734 patients, comprising 19 170 patient-years. The exacerbation rates were 0.80 and 1.09 per patient-year in the budesonide/formoterol and fluticasone/salmeterol groups, respectively (difference of 26.6%; P < 0.0001); yearly rates for COPD-related hospitalizations were 0.15 and 0.21, respectively (difference of 29.1%; P < 0.0001). All other healthcare outcomes were also significantly reduced with budesonide/formoterol versus fluticasone/salmeterol. CONCLUSIONS: Long-term treatment with fixed combination budesonide/formoterol was associated with fewer healthcare utilization-defined exacerbations than fluticasone/salmeterol in patients with moderate and severe COPD. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/23495860/Combination_of_budesonide/formoterol_more_effective_than_fluticasone/salmeterol_in_preventing_exacerbations_in_chronic_obstructive_pulmonary_disease:_the_PATHOS_study_ L2 - https://doi.org/10.1111/joim.12067 DB - PRIME DP - Unbound Medicine ER -