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Comparative Safety and Effectiveness of Inhaled Corticosteroids and Long-Acting β2 Agonist Combinations in Patients with Chronic Obstructive Pulmonary Disease
Chest ( IF 9.6 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.chest.2019.12.006 Ting-Yu Chang, Jung-Yien Chien, Chung-Hsuen Wu, Yaa-Hui Dong, Fang-Ju Lin
Chest ( IF 9.6 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.chest.2019.12.006 Ting-Yu Chang, Jung-Yien Chien, Chung-Hsuen Wu, Yaa-Hui Dong, Fang-Ju Lin
INTRODUCTION
The differential risk of pneumonia among inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) requires more investigation, especially for beclomethasone-containing inhalers. This study aimed to compare the risk and benefit profile of different ICS/long-acting β2 agonist (LABA) combinations in COPD patients. METHODS
We conducted a retrospective cohort study using national health insurance claims data from the years 2009-2015 in Taiwan and included COPD patients with new ICS/LABA use. Propensity score matching and Cox regression models were used to estimate the hazard ratios of severe pneumonia and acute exacerbation (AE) for different ICS/LABA users. RESULTS
Both budesonide/formoterol (BUD/FOR) dry-powder inhalers (DPIs) and beclomethasone/formoterol (BEC/FOR) metered-dose inhaler (MDIs), compared with fluticasone propionate/salmeterol (FLU/SAL) delivered via the same device type, were associated with a lower risk of severe pneumonia (BUD/FOR HR 0.83 [95% CI 0.70-0.98], BEC/FOR 0.69 [0.58-0.81]) and severe AE (BUD/FOR HR 0.88 [0.78-0.99], BEC/FOR 0.90 [0.84-0.96]). After additionally adjusting for the average daily ICS dose, BUD/FOR DPI users continued to have a significantly decreased risk of severe pneumonia (18%) but not BEC/FOR MDI users. The results were consistent in most of the prespecified subgroups and across all the sensitivity analyses. CONCLUSION
This study augments the existing evidence concerning the different safety and effectiveness outcomes of ICS/LABA combinations in COPD patients, which may be considered when making clinical treatment decisions.
更新日期：2020-05-01
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