Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 2445-2454 |
| Number of pages | 10 |
| Journal | International journal of chronic obstructive pulmonary disease |
| Volume | 12 |
| DOIs | |
| Publication status | Published - 17 Aug 2017 |
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Keywords
- COPD
- inhaler type
- exacerbations
- pneumonia
- diabetes
- dose-response
- inhaled steroid/LABA combination
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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. / Jones, Rupert; Martin, Jessica; Thomas, Vicky; Skinner, Derek; Marshall, Jonathan; d'Alcontres, Martina Stagno; Price, David.
In: International journal of chronic obstructive pulmonary disease , Vol. 12, 17.08.2017, p. 2445-2454.Research output: Contribution to journal › Article
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TY - JOUR
T1 - The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD
T2 - a UK database study
AU - Jones, Rupert
AU - Martin, Jessica
AU - Thomas, Vicky
AU - Skinner, Derek
AU - Marshall, Jonathan
AU - d'Alcontres, Martina Stagno
AU - Price, David
N1 - The study was funded with institutional support from Mundipharma International Limited. Study design, analysis, and data interpretation were reviewed independently by all authors.
PY - 2017/8/17
Y1 - 2017/8/17
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.
AB - 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.
KW - COPD
KW - inhaler type
KW - exacerbations
KW - pneumonia
KW - diabetes
KW - dose-response
KW - inhaled steroid/LABA combination
U2 - 10.2147/COPD.S141409
DO - 10.2147/COPD.S141409
M3 - Article
VL - 12
SP - 2445
EP - 2454
JO - International journal of chronic obstructive pulmonary disease
JF - International journal of chronic obstructive pulmonary disease
SN - 1176-9106
ER -