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Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease.
JAMA. 2014 Sep 17; 312(11):1114-21.JAMA

Abstract

IMPORTANCE

Chronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.

OBJECTIVE

To estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting.

DESIGN, SETTING, AND PATIENTS

Population-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA-inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively.

EXPOSURES

Newly prescribed combination LABAs and inhaled corticosteroids or LABAs alone.

MAIN OUTCOMES AND MEASURES

Composite outcome of death and COPD hospitalization.

RESULTS

The main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, -3.7%; 95% CI, -5.7% to -1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, -6.5%; 95% CI, -10.3% to -2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, -8.4%; 95% CI, -11.9% to -4.9%; HR, 0.79; 95% CI, 0.73-0.86).

CONCLUSIONS AND RELEVANCE

Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization.

Authors+Show Affiliations

Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada4The Hospital for Sick Children.Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada6University Health Network, Toronto, Ontario, Canada.Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada4The Hospital for Sick Children, Toronto, Ontario, Canada.Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Medicine, University of Toronto, Toronto, Ontario, Canada.Department of Medicine, University of Toronto, Toronto, Ontario, Canada7Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada5Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Pub Type(s)

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

Language

eng

PubMed ID

25226477

Citation

Gershon, Andrea S., et al. "Combination Long-acting Β-agonists and Inhaled Corticosteroids Compared With Long-acting Β-agonists Alone in Older Adults With Chronic Obstructive Pulmonary Disease." JAMA, vol. 312, no. 11, 2014, pp. 1114-21.
Gershon AS, Campitelli MA, Croxford R, et al. Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease. JAMA. 2014;312(11):1114-21.
Gershon, A. S., Campitelli, M. A., Croxford, R., Stanbrook, M. B., To, T., Upshur, R., Stephenson, A. L., & Stukel, T. A. (2014). Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease. JAMA, 312(11), 1114-21. https://doi.org/10.1001/jama.2014.11432
Gershon AS, et al. Combination Long-acting Β-agonists and Inhaled Corticosteroids Compared With Long-acting Β-agonists Alone in Older Adults With Chronic Obstructive Pulmonary Disease. JAMA. 2014 Sep 17;312(11):1114-21. PubMed PMID: 25226477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination long-acting β-agonists and inhaled corticosteroids compared with long-acting β-agonists alone in older adults with chronic obstructive pulmonary disease. AU - Gershon,Andrea S, AU - Campitelli,Michael A, AU - Croxford,Ruth, AU - Stanbrook,Matthew B, AU - To,Teresa, AU - Upshur,Ross, AU - Stephenson,Anne L, AU - Stukel,Thérèse A, PY - 2014/9/17/entrez PY - 2014/9/17/pubmed PY - 2014/10/21/medline SP - 1114 EP - 21 JF - JAMA JO - JAMA VL - 312 IS - 11 N2 - IMPORTANCE: Chronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes. OBJECTIVE: To estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting. DESIGN, SETTING, AND PATIENTS: Population-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA-inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively. EXPOSURES: Newly prescribed combination LABAs and inhaled corticosteroids or LABAs alone. MAIN OUTCOMES AND MEASURES: Composite outcome of death and COPD hospitalization. RESULTS: The main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, -3.7%; 95% CI, -5.7% to -1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, -6.5%; 95% CI, -10.3% to -2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, -8.4%; 95% CI, -11.9% to -4.9%; HR, 0.79; 95% CI, 0.73-0.86). CONCLUSIONS AND RELEVANCE: Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/25226477/Combination_long_acting_β_agonists_and_inhaled_corticosteroids_compared_with_long_acting_β_agonists_alone_in_older_adults_with_chronic_obstructive_pulmonary_disease_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2014.11432 DB - PRIME DP - Unbound Medicine ER -