Combination therapy beneficial for COPD patients

By Nikki Withers, medwireNews Reporter

Research published in JAMA supports the use of a combination of long-acting β-agonists (LABAs) and inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD).

The study found that patients receiving combination therapy, and particularly those with asthma and those not receiving a long-acting anticholinergic (LAA) medication, had a significantly reduced risk of death or COPD hospitalisation compared with those treated with LABAs alone.

“Our findings contribute new knowledge to the treatment of people with COPD with and without a co-diagnosis of asthma”, the authors write.

Andrea Gershon (Institute for Clinical Evaluative Sciences, Toronto, Canada) and co-authors explain that combination therapy consisting of LABAs and ICSs has previously been shown to decrease exacerbations and possibly decrease mortality compared with placebo. “However, there are still gaps in what is known about its comparative effectiveness compared with LABAs alone”, they say.

To address this, the team analysed the long-term benefits of LABA-ICS combination therapy and LABA monotherapy in over 11,000 individuals aged 66 years or older who had been diagnosed with COPD.

Of these, 8712 were new users of LABA-ICS combination therapy and 3160 were new users of LABAs alone. They were followed up for a median of 2.7 and 2.5 years, respectively.

The primary composite study outcome was death and COPD hospitalisation at 5 years and this was significantly different between the two groups, with those receiving combination therapy being at an 8% lower risk than those receiving LABAs alone.

Similarly lower risks were also observed for mortality and COPD hospitalisations analysed separately, the researchers note.

In a subgroup analysis, Gershon et al found that the greatest benefit was seen for patients with asthma and those not receiving an LAA medication, where the risk reductions for COPD hospitalisation and death associated with combination therapy were 16% and 21%, respectively.

They say this study therefore helps clarify the management of patients with COPD and asthma, as many studies of COPD medications have excluded people with asthma and vice versa.

“These findings should be confirmed in [randomised controlled trials]”, the authors conclude.

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