Comparing initial LABA-ICS inhalers in COPD: Real-world effectiveness and safety

Area of Science:

• Pulmonology
• Pharmacology
• Real-world evidence

Background:

• Current COPD guidelines recommend long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combination inhalers for patients with multiple exacerbations and eosinophilia, without specifying agent preference.
• Eosinophilia is a key marker indicating the effectiveness of ICS in COPD management.

Purpose of the Study:

• To compare the real-world effectiveness and safety of budesonide-formoterol versus fluticasone-salmeterol in COPD patients.
• To evaluate the incidence of exacerbations and pneumonia in relation to eosinophil counts.

Main Methods:

• A retrospective cohort study using the UK's CPRD database (2002-2018) identified new users of LABA-ICS inhalers aged 50+.
• Patients were followed for one year, and Cox regression models, weighted by propensity score, were used to estimate hazard ratios (HR) for exacerbations and pneumonia.

Main Results:

• The cohort comprised 24,973 budesonide-formoterol users and 61,251 fluticasone-salmeterol users.
• Budesonide-formoterol showed a similar HR for moderate-severe exacerbations (0.98) but a lower HR for severe exacerbations (0.92) compared to fluticasone-salmeterol.
• The HR for severe pneumonia was significantly lower with budesonide-formoterol (0.76), particularly in patients with eosinophil counts >300 cells/μL (HR: 0.62).

Conclusions:

• Budesonide-formoterol and fluticasone-salmeterol demonstrate comparable effectiveness in reducing moderate-to-severe COPD exacerbations in real-world practice.
• Budesonide-formoterol offers superior protection against severe exacerbations and severe pneumonia, with a pronounced benefit observed in patients with elevated blood eosinophil counts.