COPD Maintenance Therapy: Adverse Outcomes With Tiotropium/Olodaterol vs LABA/ICS

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In patients with COPD, tiotropium/olodaterol was associated with a lower risk for escalation to triple therapy or the development of adverse outcomes compared with LABA/ICS.

After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

In patients with chronic obstructive pulmonary disease (COPD), treatment with tiotropium/olodaterol (Tio/Olo) was associated with a lower risk for escalation to triple therapy or the development of adverse outcomes compared with the use of long-acting β2-agonist/inhaled corticosteroid (LABA/ICS) combination therapies, according to findings intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

Researchers conducted a noninterventional database study using data derived from healthcare claims and the results of laboratory tests from the HealthCore Integrated Research Database.  Patients with COPD who initiated treatment with Tio/Olo vs any LABA/ICS combination between January 2013 and March 2019 were included.

Investigators sought to examine the risk for escalation to some form of triple therapy and an adverse outcome composite measure — that is, escalation to triple therapy, COPD exacerbation, or pneumonia — in patients with COPD who initiated maintenance treatment with Tio/Olo vs treatment with any LABA/ICS combination therapy. At cohort entry, all patients were aged ≥40 years and had a COPD diagnosis, but not an asthma diagnosis.

The researchers defined escalation to triple therapy as the addition of ICS to Tio/Olo or the addition of a long-acting muscarinic antagonist (LAMA) to LABA/ICS. Exacerbation of COPD was defined as COPD-related hospitalization or emergency department visit for COPD and/or the prescribing of an antibiotic the same day as an oral corticosteroid. Pneumonia was defined as hospitalization for community-acquired pneumonia.

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Following reweighting for stratified propensity scores, the total study population totaled 42,953 individuals. The mean patient age was 65 years, and 54.5% of the patients were women. Tio/Olo was used in 2600 patients, and LABA/ICS was used in 40,353 patients. Escalation to triple therapy was less common in patients treated with Tio/Olo (hazard ratio [HR], 0.23; 95% CI, 0.19-0.27), as was the development of an adverse outcome (HR, 0.46; 95% CI, 0.42-0.51), compared with patients treated with a LABA/ICS combination.

The investigators concluded that treatment with Tio/Olo demonstrated a lower risk for escalation to triple therapy or adverse outcomes compared with LABA/ICS in patients with COPD. These findings were reported regardless of patients’ baseline eosinophil counts or history of disease exacerbation.


Quint JK, Montonen J, Esposito DB, et al. COPD maintenance therapy with tiotropium/olodaterol versus LABA/ICS: an assessment of the risk of treatment escalation and adverse outcomes in over 40,000 patientsAm J Respir Crit Care Med. 2020;201:A5072.