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Comparative Effectiveness of Long-Acting Beta2 -Agonist Combined with a Long-Acting Muscarinic Antagonist or Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease.
Pharmacotherapy. 2017 Apr; 37(4):447-455.P

Abstract

INTRODUCTION

Several dual bronchodilator fixed-dose inhaler medications were recently approved for the treatment of chronic obstructive pulmonary disease (COPD). These products combine a long-acting β2 -agonist (LABA) and long-acting muscarinic antagonist (LAMA). In clinical trials, the separate mechanisms of the bronchodilators resulted in improved lung function. COPD treatment guidelines currently recommend combination LABA/LAMA as alternative therapy to combination LABA/inhaled corticosteroid (ICS). Evidence is limited on the comparative effectiveness of LABA/LAMA and LABA/ICS in COPD. The objective of this study was to compare real-world COPD exacerbation rates among patients treated with LABA/LAMA with those treated with LABA/ICS.

METHODS

This was a retrospective observational study of COPD patients in the United States treated with LABA/LAMA or LABA/ICS combination. Insurance claims from January 1, 2004, through December 31, 2014, were used as the data source. Patients were required to have greater than one prescription filled for the combination medications, and they were followed from 30 days after drug initiation. Individuals were censored if they discontinued a study medication, initiated medication from the opposite cohort (LAMA or ICS), lost enrollment eligibility, or at the study period end. Exacerbation rates were compared using Poisson regression.

RESULTS

There were 5384 patients in the LABA/LAMA cohort and 473,388 patients in the LABA/ICS cohort. The LABA/LAMA cohort was older, had more comorbidities, and more severe COPD. Unadjusted annual exacerbation rates were 2.87 events per person-year (standard deviation [SD] 5.14) in the LABA/LAMA cohort and 1.68 (SD 9.82) in the LABA/ICS cohort. The adjusted incidence rate ratio was 0.98 (95% confidence interval 0.95-1.01) for LABA/LAMA compared with LABA/ICS.

CONCLUSIONS

The LABA/LAMA combination had similar effectiveness to LABA/ICS as measured by exacerbation rates in COPD patients. As a result, characteristics other than effectiveness, such as symptom control, cost, patient preferences, and adverse events, may be important in selecting between the two regimens.

Authors+Show Affiliations

Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois.Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois. Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois.Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois.Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois.Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois. Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

28226405

Citation

Samp, Jennifer C., et al. "Comparative Effectiveness of Long-Acting Beta2 -Agonist Combined With a Long-Acting Muscarinic Antagonist or Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease." Pharmacotherapy, vol. 37, no. 4, 2017, pp. 447-455.
Samp JC, Joo MJ, Schumock GT, et al. Comparative Effectiveness of Long-Acting Beta2 -Agonist Combined with a Long-Acting Muscarinic Antagonist or Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease. Pharmacotherapy. 2017;37(4):447-455.
Samp, J. C., Joo, M. J., Schumock, G. T., Calip, G. S., Pickard, A. S., & Lee, T. A. (2017). Comparative Effectiveness of Long-Acting Beta2 -Agonist Combined with a Long-Acting Muscarinic Antagonist or Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease. Pharmacotherapy, 37(4), 447-455. https://doi.org/10.1002/phar.1913
Samp JC, et al. Comparative Effectiveness of Long-Acting Beta2 -Agonist Combined With a Long-Acting Muscarinic Antagonist or Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease. Pharmacotherapy. 2017;37(4):447-455. PubMed PMID: 28226405.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative Effectiveness of Long-Acting Beta2 -Agonist Combined with a Long-Acting Muscarinic Antagonist or Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease. AU - Samp,Jennifer C, AU - Joo,Min J, AU - Schumock,Glen T, AU - Calip,Gregory S, AU - Pickard,A Simon, AU - Lee,Todd A, PY - 2017/2/23/pubmed PY - 2017/10/5/medline PY - 2017/2/23/entrez KW - bronchodilator KW - chronic obstructive pulmonary disease KW - inhaled corticosteroid KW - long-acting beta2-agonist KW - long-acting muscarinic antagonist KW - treatment SP - 447 EP - 455 JF - Pharmacotherapy JO - Pharmacotherapy VL - 37 IS - 4 N2 - INTRODUCTION: Several dual bronchodilator fixed-dose inhaler medications were recently approved for the treatment of chronic obstructive pulmonary disease (COPD). These products combine a long-acting β2 -agonist (LABA) and long-acting muscarinic antagonist (LAMA). In clinical trials, the separate mechanisms of the bronchodilators resulted in improved lung function. COPD treatment guidelines currently recommend combination LABA/LAMA as alternative therapy to combination LABA/inhaled corticosteroid (ICS). Evidence is limited on the comparative effectiveness of LABA/LAMA and LABA/ICS in COPD. The objective of this study was to compare real-world COPD exacerbation rates among patients treated with LABA/LAMA with those treated with LABA/ICS. METHODS: This was a retrospective observational study of COPD patients in the United States treated with LABA/LAMA or LABA/ICS combination. Insurance claims from January 1, 2004, through December 31, 2014, were used as the data source. Patients were required to have greater than one prescription filled for the combination medications, and they were followed from 30 days after drug initiation. Individuals were censored if they discontinued a study medication, initiated medication from the opposite cohort (LAMA or ICS), lost enrollment eligibility, or at the study period end. Exacerbation rates were compared using Poisson regression. RESULTS: There were 5384 patients in the LABA/LAMA cohort and 473,388 patients in the LABA/ICS cohort. The LABA/LAMA cohort was older, had more comorbidities, and more severe COPD. Unadjusted annual exacerbation rates were 2.87 events per person-year (standard deviation [SD] 5.14) in the LABA/LAMA cohort and 1.68 (SD 9.82) in the LABA/ICS cohort. The adjusted incidence rate ratio was 0.98 (95% confidence interval 0.95-1.01) for LABA/LAMA compared with LABA/ICS. CONCLUSIONS: The LABA/LAMA combination had similar effectiveness to LABA/ICS as measured by exacerbation rates in COPD patients. As a result, characteristics other than effectiveness, such as symptom control, cost, patient preferences, and adverse events, may be important in selecting between the two regimens. SN - 1875-9114 UR - https://www.unboundmedicine.com/medline/citation/28226405/Comparative_Effectiveness_of_Long_Acting_Beta2__Agonist_Combined_with_a_Long_Acting_Muscarinic_Antagonist_or_Inhaled_Corticosteroid_in_Chronic_Obstructive_Pulmonary_Disease_ L2 - https://doi.org/10.1002/phar.1913 DB - PRIME DP - Unbound Medicine ER -