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Comparative effectiveness of fixed-dose inhaled corticosteroid/long-acting beta-agonist therapy in adult patients
Te-Jung Kung1, Ching-Fu Weng2, Shan-Chieh Wu3
1Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Background:
Inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA) therapy is a mainstay of asthma management, yet real-world comparative evidence across different formulations remains limited.
Objective:
To compare the effectiveness of prescribed fixed-dose ICS/LABA combinations in reducing moderate-to-severe asthma exacerbations (MSAEs) among adults, stratified by initial ICS dose.
Methods:
This retrospective cohort study used data from Taiwan's National Health Insurance Research Database and Cause of Death Registry (2016-2021). Adults with asthma who initiated fixed-dose ICS/LABA therapy between 2017 and 2020 were included. Treatment groups comprised budesonide/formoterol (reference), extrafine beclometasone dipropionate/formoterol, fluticasone propionate/salmeterol, and fluticasone furoate/vilanterol. Patients were stratified by initial ICS dosage into low-dose and medium-to-high-dose cohorts. Risk of MSAE was assessed using Cox proportional hazards model with inverse probability of treatment weighting for covariate adjustment.
Results:
Among 128,426 eligible patients, 35,532 were in the low-dose and 88,954 in the medium-to-high-dose cohort. In the low-dose cohort, extrafine beclometasone dipropionate/formoterol (hazard ratio [HR]: 0.97, 95% CI: 0.88-1.09) and fluticasone propionate/salmeterol (HR: 1.16, 95% CI: 0.98-1.37) had a similar risk of MSAE compared with budesonide/formoterol. In the medium-to-high-dose cohort, fluticasone furoate/vilanterol was associated with a slightly lower MSAE risk compared with budesonide/formoterol (HR: 0.92, 95% CI: 0.86-0.97), particularly in those with prior exacerbations (HR: 0.84, 95% CI: 0.77-0.91). Extrafine beclometasone dipropionate/formoterol (HR: 0.96, 95% CI: 0.89-1.04) and fluticasone propionate/salmeterol (HR: 1.06, 95% CI: 0.98-1.15) had no significant difference.
Conclusion:
The findings suggest that fluticasone furoate/vilanterol may offer a potential advantage for asthma management compared with other fixed-dose ICS/LABA combinations.
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