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The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD: a UK database study.
Int J Chron Obstruct Pulmon Dis. 2017; 12:2445-2454.IJ

Abstract

Chronic obstructive pulmonary disease (COPD), a complex progressive disease, is currently the third leading cause of death worldwide. One recommended treatment option is fixed-dose combination therapy of an inhaled corticosteroid (ICS)/long-acting β-agonist. Clinical trials suggest pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) show similar efficacy and safety profiles in COPD. Real-world observational studies have shown that combination therapy has significantly greater odds of achieving asthma control when delivered via pMDIs. Our aim was to compare effectiveness, in terms of moderate/severe COPD exacerbations and long-acting muscarinic antagonist (LAMA) prescriptions, for COPD patients initiating fluticasone propionate (FP)/salmeterol xinafoate (SAL) via pMDI versus DPI at two doses of FP (500 and 1,000 μg/d) using a real-life, historical matched cohort study. COPD patients with ≥2 years continuous practice data, ≥2 prescriptions for FP/SAL via pMDI/DPI, and no prescription for ICS were selected from the Optimum Patient Care Research Database. Patients were matched 1:1. Rate of moderate/severe COPD exacerbations and odds of LAMA prescription were analyzed using conditional Poisson and logistic regression, respectively. Of 472 patients on 500 μg/d, we observed fewer moderate/severe exacerbations in patients using pMDI (99 [42%]) versus DPI (115 [49%]) (adjusted rate ratio: 0.71; 95% confidence interval: 0.54, 0.93), an important result since the pMDI is not licensed for COPD in the UK, USA, or China. At 1,000 μg/d, we observed lower LAMA prescription for pMDI (adjusted odds ratio: 0.71; 95% confidence interval: 0.55, 0.91), but no difference in exacerbation rates, potentially due to higher dose of ICS overcoming low lung delivery from the DPI.

Authors+Show Affiliations

Clinical Trials and Health Research, Institute of Translational and Stratified Medicine, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK.Observational and Pragmatic Research Institute, Singapore.Cambridge Research Support, Cambridge, UK.Optimum Patient Care, Cambridge, UK.Mundipharma International Limited, Cambridge, UK.Observational and Pragmatic Research Institute, Singapore.Observational and Pragmatic Research Institute, Singapore. Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

28860739

Citation

Jones, Rupert, et al. "The Comparative Effectiveness of Initiating Fluticasone/salmeterol Combination Therapy Via pMDI Versus DPI in Reducing Exacerbations and Treatment Escalation in COPD: a UK Database Study." International Journal of Chronic Obstructive Pulmonary Disease, vol. 12, 2017, pp. 2445-2454.
Jones R, Martin J, Thomas V, et al. The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD: a UK database study. Int J Chron Obstruct Pulmon Dis. 2017;12:2445-2454.
Jones, R., Martin, J., Thomas, V., Skinner, D., Marshall, J., Stagno d'Alcontres, M., & Price, D. (2017). The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD: a UK database study. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2445-2454. https://doi.org/10.2147/COPD.S141409
Jones R, et al. The Comparative Effectiveness of Initiating Fluticasone/salmeterol Combination Therapy Via pMDI Versus DPI in Reducing Exacerbations and Treatment Escalation in COPD: a UK Database Study. Int J Chron Obstruct Pulmon Dis. 2017;12:2445-2454. PubMed PMID: 28860739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD: a UK database study. AU - Jones,Rupert, AU - Martin,Jessica, AU - Thomas,Vicky, AU - Skinner,Derek, AU - Marshall,Jonathan, AU - Stagno d'Alcontres,Martina, AU - Price,David, Y1 - 2017/08/17/ PY - 2017/9/2/entrez PY - 2017/9/2/pubmed PY - 2018/5/15/medline KW - COPD KW - diabetes KW - dose-response KW - exacerbations KW - inhaled steroid/LABA combination KW - inhaler type KW - pneumonia SP - 2445 EP - 2454 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 12 N2 - Chronic obstructive pulmonary disease (COPD), a complex progressive disease, is currently the third leading cause of death worldwide. One recommended treatment option is fixed-dose combination therapy of an inhaled corticosteroid (ICS)/long-acting β-agonist. Clinical trials suggest pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) show similar efficacy and safety profiles in COPD. Real-world observational studies have shown that combination therapy has significantly greater odds of achieving asthma control when delivered via pMDIs. Our aim was to compare effectiveness, in terms of moderate/severe COPD exacerbations and long-acting muscarinic antagonist (LAMA) prescriptions, for COPD patients initiating fluticasone propionate (FP)/salmeterol xinafoate (SAL) via pMDI versus DPI at two doses of FP (500 and 1,000 μg/d) using a real-life, historical matched cohort study. COPD patients with ≥2 years continuous practice data, ≥2 prescriptions for FP/SAL via pMDI/DPI, and no prescription for ICS were selected from the Optimum Patient Care Research Database. Patients were matched 1:1. Rate of moderate/severe COPD exacerbations and odds of LAMA prescription were analyzed using conditional Poisson and logistic regression, respectively. Of 472 patients on 500 μg/d, we observed fewer moderate/severe exacerbations in patients using pMDI (99 [42%]) versus DPI (115 [49%]) (adjusted rate ratio: 0.71; 95% confidence interval: 0.54, 0.93), an important result since the pMDI is not licensed for COPD in the UK, USA, or China. At 1,000 μg/d, we observed lower LAMA prescription for pMDI (adjusted odds ratio: 0.71; 95% confidence interval: 0.55, 0.91), but no difference in exacerbation rates, potentially due to higher dose of ICS overcoming low lung delivery from the DPI. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/28860739/The_comparative_effectiveness_of_initiating_fluticasone/salmeterol_combination_therapy_via_pMDI_versus_DPI_in_reducing_exacerbations_and_treatment_escalation_in_COPD:_a_UK_database_study_ L2 - https://dx.doi.org/10.2147/COPD.S141409 DB - PRIME DP - Unbound Medicine ER -