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Original Article
Available online 24 May 2022
Effectiveness of Treatment With Dual Bronchodilation (LABA/LAMA) Compared With Combination Therapy (LABA/ICS) for Patients With COPD: A Population-Based Study
Efectividad del tratamiento con broncodilatación dual (LABA/LAMA) comparado con la terapia combinada (LABA/ICS) en pacientes con EPOC: Un estudio de base poblacional
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Mònica Monteagudoa,b, Alexa Nuñezc, Miriam Barrechegurenc, Marc Miravitllesc,
Corresponding author
marcm@separ.es

Corresponding author.
a Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
b Medicine Department, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
c Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Tables (3)
Table 1. Baseline characteristics of the study population in general and according to COPD subcohorts.
Table 2. Time in months between the start of the study treatment and the appearance of the first event according to COPD subgroups (COPD confirmed and COPD matched cohorts).
Table 3. Time in months between the start of the study treatment and the appearance of the first event in patients according to risk subgroups and according to COPD subgroups (COPD confirmed and COPD matched cohorts).
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Abstract
Background

Initiation of treatment of COPD with a combination of a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS) is frequent irrespective of the risk of exacerbations.

Method

We performed a retrospective, population-based, observational study aimed at comparing the effectiveness of a LABA/long-acting antimuscarinic agent (LAMA) and LABA/ICS in patients with COPD over a one-year follow-up. Data were obtained from an administrative healthcare claims database. The primary outcome was the risk of first exacerbation. A sensitivity analysis was conducted in a propensity-score matched population.

Results

The population consisted of 14,046 COPD patients; 11,329 (80.6%) initiated LABA/ICS and 2717 (19.4%) LABA/LAMA. The matched population included 1650 patients in each arm. During follow-up, 69.6% patients in the LABA/ICS group and 64.4% in the LABA/LAMA group presented an exacerbation. The mean time to the first exacerbation was 6.03 months (95% confidence interval (CI): 5.94–6.12) for LABA/ICS and 6.4 months (95%CI: 6.21–6.59) for LABA/LAMA; p<0.001. The time to scalation to triple therapy was also significantly prolonged in LABA/LAMA. Similar results were obtained in the matched population. LABA/LAMA was associated with a significantly lower risk of exacerbations and escalation to triple therapy compared to LABA/ICS, except in patients with frequent exacerbations and high blood eosinophils in which no differences were observed in the time to first exacerbation.

Conclusion

Initiation of treatment with LABA/LAMA was associated with a lower risk of exacerbation and escalation to triple therapy compared to LABA/ICS in the majority of patients with COPD in primary care.

Keywords:
COPD
Treatment
Effectiveness
Inhaled corticosteroids
Long-acting bronchodilators
Resumen
Contexto general

El inicio del tratamiento de la EPOC con la combinación de un beta adrenérgico de larga duración (LABA) y un corticosteroide inhalado (ICS) es frecuente en pacientes con EPOC.

Método

Estudio observacional, retrospectivo y de base poblacional para comparar la efectividad de un LABA/antimuscarínico de larga duración (LAMA) y un LABA/ICS en pacientes con EPOC. Los datos se obtuvieron de una base de datos de salud de base poblacional. El objetivo primario fue el riesgo de una primera agudización. Se realizó un análisis de sensibilidad en una población seleccionada por concordancia de sus características mediante “propensity-score”.

Resultados

La población consistió en 14.046 pacientes, 11.329 (80,6%) iniciaron LABA/ICS y 2.717 (19,4%) LABA/LAMA. La población concordante incluyó 1.650 pacientes de cada rama. Durante el seguimiento, 69,6% de pacientes con LABA/ICS y 64,4% con LABA/LAMA presentaron una agudización. EL tiempo medio hasta la primera agudización fue de 6,03 meses (intervalo de confianza (IC) del 95%: 5,94 a 6,12) para LABA/ICS y 6,4 meses (IC95%: 6,21 a 6,59) para LABA/LAMA; p<0,001. El tiempo hasta el escalado a triple terapia fue también significativamente más largo con LABA/LAMA. Los resultados fueron similares en la población con características concordantes. Solamente en pacientes con agudizaciones frecuentes y valores elevados de eosinófilos en sangre no se observaron diferencias en el tiempo hasta la primera agudización.

Conclusiones

El tratamiento con LABA/LAMA se asoció con un menor riesgo de agudización y escalado a triple terapia comparado con LABA/ICS en la mayoría de pacientes con EPOC en atención primaria

Palabras clave:
EPOC
tratamiento
efectividad
corticosteroides inhalados
broncodilatadores de larga duración

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