Use of inhalers containing a combination of long-acting muscarinic antagonists (LAMAs) and long-acting β-agonists (LABAs) in patients with chronic obstructive pulmonary disease (COPD) markedly reduces the incidence of acute exacerbations as well as hospitalizations due to pneumonia compared to the use of inhalers containing inhaled corticosteroids (ICSs) and LABAs. The study findings are published in JAMA Internal Medicine.¹

In this 1:1 propensity score-matched cohort study of patients with COPD, researchers examined 30,216 matched patient pairs who had been newly prescribed LAMA-LABA or ICS-LABA inhalers between 2014 and 2019. For this they obtained data from an insurance claims database. The mean age of the study population was 70 years and half of them were female. Patients were followed up for one year until the treatment was either changed or stopped or the insurance coverage ended or death occurred.

The various LAMA-LABA combinations included aclidinium-formoterol, glycopyrronium-formoterol, glycopyrronium-indacaterol, tiotropium-olodaterol, or umeclidinium-vilanterol, while the ICS-LABA combinations were budesonide-formoterol, fluticasone-salmeterol, fluticasone-vilanterol, or mometasone-formoterol.

The incidence of first moderate or severe exacerbation events in the LAMA-LABA group was 320.6 per 1,000 person-years vs 363.6 per 1,000 person-years in the ICS-LABA group.

The overall rate of first moderate or severe COPD exacerbation, which was a primary effectiveness outcome, declined by 8% among patients using the LAMA-LABA combination with HR of 0.92 compared to treatment with ICS-LABA inhaler. A 7% reduction in moderate exacerbation was noted with LAMA-LABA inhaler use (HR 0.93), while severe exacerbations reduced by 15% (HR 0.85). The incidence rate of hospitalization due to pneumonia was 82.1 per 1,000 person-years compared to 104.0 per 1,000 person-years in the LAMA-LABA group vs ICS-LABA group. The rate of hospitalization due to a first episode of pneumonia, which was the primary safety outcome, was also reduced by 20% with HR of 0.80.

Patients on ICS-LABA had higher probability of having GOLD stage E disease at baseline vs the LAMA-LABA group; 16.7% vs 12.5%, respectively. At least half of patients prescribed LAMA-LABAs were more likely to have spirometry data at baseline vs those who had been prescribed ICS-LABAs; 50.2% vs 30.7%, respectively. They were also more likely to have their first prescription from a pulmonologist; 11.4% vs 4.5%, respectively.

This study compared the outcomes of LAMA-LABA combination therapy with ICS-LABA combination therapy in patients with COPD. The findings showed that patients using ICS-LABA inhalers had more frequent moderate or severe exacerbations including hospitalizations for pneumonia suggesting that LAMA-LABA therapy, not LAMA-LABA, should be the preferred treatment option for patients with COPD for better clinical outcomes.

Reference

1.     Feldman WB, et al. Chronic obstructive pulmonary disease exacerbations and pneumonia hospitalizations among new users of combination maintenance inhalers. JAMA Intern Med. 2023 May 22;e231245. doi: 10.1001/jamainternmed.2023.1245.