A Comparison of the Real-Life Clinical Effectiveness of the Leading Licensed ICS/LABA Combination Inhalers in the Treatment for COPD.

Simon Wan Yau Ming, John Haughney, Dermot Ryan, Iain Small, Federico Lavorini, Alberto Papi, Dave Singh, David M G Halpin, John R Hurst, Shishir Patel, Matthias Ochel, Janwillem Kocks, Victoria Carter, Antony Hardjojo, David B Price

Journal: International journal of chronic obstructive pulmonary disease 2021;15():3093-3103

PMID: 33273812

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Abstract

INTRODUCTION

The Fostair® 100/6 (BDP/FF) pressurized metered-dose inhaler, delivering an extrafine formulation, is licensed for asthma and COPD in the UK. However, its real-life effectiveness for COPD has not been evaluated. This study compared the clinical effectiveness of BDP/FF against other licensed ICS/LABA combination inhalers: the Seretide® Accuhaler® (FP/SAL) and the Symbicort® Turbohaler® (BUD/FF).

METHODS

A matched historical cohort study was conducted using records of patients with diagnostic codes for COPD from the Optimum Patient Care Research Database (OPCRD). Patients who had received BDP/FF as their first ICS/LABA were matched 1:1 with patients who had received FP/SAL or BUD/FF, resulting in two matched comparisons. Additional analysis was conducted on patients who had never had diagnostic codes for asthma. Noninferiority in terms of the proportion of patients with moderate/severe COPD exacerbations on the different inhalers in the following year was assessed. Noninferiority was achieved if the upper CI limit were ≤1.2.

RESULTS

This study included 537 and 540 patient pairs in the BDP/FF vs FP/SAL cohort and the BDP/FF vs BUD/FF cohort, respectively. The proportion of patients with COPD exacerbations in the BDP/FF group was not significantly different from either the FP/SAL (68.7% vs 70.2%, AOR 0.89, 95% CI 0.67-1.19) or BUD/FF group (68.5% vs 69.4%, AOR 0.79, 95% CI 0.58-1.08). Noninferiority of BDP/FF in preventing COPD exacerbations was fulfilled in both comparisons. In patients without asthma, BDP/FF was also noninferior to BUD/FF (proportion with COPD exacerbations, 67.8% vs 64.7%, AOR 0.79, 95% CI 0.51-1.1997). Additionally, a significantly lower proportion of patients prescribed BDP/FF had COPD exacerbations than FP/SAL (64.8% vs 73.7%, AOR 0.64 95% CI 0.43-0.96).

CONCLUSION

Initiating ICS/LABA treatment of COPD with extrafine-formulation BDP/FF was noninferior in preventing moderate/severe exacerbations compared to FP/SAL and BUD/FF.

Address: Observational and Pragmatic Research Institute, Singapore, Singapore.; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.; Optimum Patient Care, Cambridge, UK.; Peterhead Health Centre, Aberdeen, UK.; Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.; University of Ferrara, Ferrara, Italy.; University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK.; Royal Devon and Exeter Hospital, Exeter, UK.; UCL Respiratory, University College London, London, UK.; Chiesi Limited, Manchester, UK.; Observational and Pragmatic Research Institute, Singapore, Singapore.; General Practitioners Research Institute, Groningen, the Netherlands.; University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands.; Observational and Pragmatic Research Institute, Singapore, Singapore.; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

DOI: 10.2147/COPD.S263745

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MeSH Terms: Administration, Inhalation, Cohort Studies, Drug Combinations, Formoterol Fumarate, Humans, Nebulizers and Vaporizers, Pulmonary Disease, Chronic Obstructive, Treatment Outcome