COPD EXACERBATIONS AND PNEUMONIA HOSPITALIZATIONS IN NEW USERS OF COMBINATION MAINTENANCE INHALERS: A COMPARATIVE EFFECTIVENESS AND SAFETY STUDY

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Current guidelines recommend inhalers containing long-acting muscarinic antagonists (LAMA) and long-acting beta agonists (LABA) over inhalers containing inhaled corticosteroids (ICS) and LABAs as first-line dual therapy for chronic obstructive pulmonary disease (COPD). However, recent data from randomized controlled trials examining the efficacy and safety of LAMA-LABA versus ICS-LABA inhalers have been conflicting and raised concerns of generalizability. The purpose of this study was to determine whether LAMA-LABA therapy is associated with reduced COPD exacerbations and pneumonia hospitalizations compared to ICS-LABA therapy in real-world clinical practice. METHODS: A 1:1 propensity-score matched observational cohort study was conducted using a large US commercial insurance database. The study included patients with COPD who filled a new prescription for a combination LAMA-LABA or ICS-LABA inhaler between January 1, 2014 to December 31, 2019. Patients with a prior diagnosis of asthma were excluded. The primary effectiveness outcome was first moderate or severe COPD exacerbation, and the primary safety outcome was first pneumonia hospitalization. RESULTS: Among 138,395 patients (107,518 new ICS-LABA users and 30,877 new LAMA-LABA users), 30,772 matched pairs were identified for the primary analysis. The propensity-score matched cohort had a mean age of 70 years and 47% were women. Compared to ICS-LABA use, LAMA-LABA use was associated with a 10% reduction in the rate of first moderate or severe COPD exacerbation (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.87, 0.94) and a 24% reduction in the rate of first pneumonia hospitalization (HR 0.76, 95% CI 0.70, 0.84). These findings were robust across a range of prespecified sensitivity and subgroup analyses. CONCLUSIONS: LAMA-LABA therapy was associated with improved clinical outcomes compared to ICS-LABA therapy in a cohort of patients treated in routine clinical practice. CLINICAL IMPLICATIONS: In keeping with current guidelines, LAMA-LABA therapy should be preferred to ICS-LABA therapy for most patients with COPD. DISCLOSURES: No relevant relationships by Jerry Avorn, source=Web Response Consultant relationship with Alosa Health Please note: 2019-present Added 04/14/2021 by William Feldman, source=Web Response, value=Consulting fee Consultant relationship with Aetion Please note: 2019-2020 Added 04/14/2021 by William Feldman, source=Web Response, value=Consulting fee Consultant relationship with Blue Cross Blue Shield of Massachusetts Please note: 2019-2020 Added 04/14/2021 by William Feldman, source=Web Response, value=Honoraria no disclosure on file for Joshua Gagne; No relevant relationships by Aaron Kesselheim, source=Web Response