For most patients with chronic obstructive pulmonary disease (COPD), dual bronchodilation with a long-acting beta-agonist (LABA) and a long-acting antimuscarinic agent (LAMA) offers less risk of exacerbation and progression to triple therapy than LABA combined with an inhaled corticosteroid (ICS). This was among the results of a retrospective, population-based, observational study conducted in Barcelona, Spain, and published in Archivos de Bronconeumologia.
LABA/ICS is prescribed routinely for COPD, but the research backing up this protocol has produced contradictory results. Study authors sought to determine whether LABA/LAMA would be more effective in preventing exacerbations than LABA/ICS.
Study investigators analyzed data from 14,046 adults over age 40 with COPD treated with either LABA/ICS (n= 11,329; 80.6%) or LABA/LAMA (n=2717; 19.4%), using medical records data from the Information System for the Development of Research in Primary Care, a large database including medical records of more than 80% of the population of Catalonia, Spain. The researchers also selected 3300 of these study participants who had exacerbation risk factors for inclusion in 2 matched cohorts for additional analyses.
An analysis all 14,046 patients studied showed that 69.6% receiving LABA/ICS and 64.4% receiving LABA/LAMA experienced an exacerbation over 1-year of follow-up. The mean time to first exacerbation in the LABA/ICS group was 6.03 months (95% CI, 5.94-6.12) vs 6.40 months (95% CI, 6.21-6.59) in the LABA/LAMA group (P <.001). The interval before progression to triple therapy also was longer in the LABA/LAMA group. These findings were statistically significant and were reproduced in the smaller matched cohort.
Notably, although use of LABA/LAMA therapy was generally associated with a significantly lower risk of exacerbations and escalation to triple therapy compared with use of LABA/ICS, this was not the case in patients with frequent exacerbations and high blood eosinophil levels, who are more likely to respond to ICS. Among these patients, investigators saw no differences in time to first exacerbation with LABA/LAMA vs ICS use. These patients are expected to have better treatment response with ICS.
The principal limitation of the study was the possibility of underreporting of exacerbations due to patient error in reporting or unmeasured confounders.
“These conclusions are very relevant for clinical practice because the majority of patients in primary care in different countries are infrequent exacerbators,” the authors noted. “Our results support the current recommendations to initiate treatment with LABA/LAMA before introducing an ICS or escalat[ing] to triple therapy,” they concluded.
Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Monteagudo M, Nuñez A, Barrecheguren M, Miravitlles M. Effectiveness of treatment with dual bronchodilation (LABA/LAMA) compared with combination therapy (LABA/ICS) for patients with COPD: a population-based study. Arch Bronconeumol. Published online May 13, 2022. doi:10.1016/j.arbres.2022.05.002