Results from a recent study published in the journal Respiratory Research show no difference in COPD-related exacerbations or pneumonia events between patients receiving budesonide/formoterol combination (BFC) and fluticasone/salmeterol combination (FSC) in patients new to inhaled corticosteroid/long-acting β2-agonist combinations (ICS/LABA) treatment.
The GOLD 2014 treatment guidelines support the initiation of controller medications for patients with COPD symptoms and exacerbations. Inhaled corticosteroid/long-acting β2- agonist combinations (ICS/LABA) are endorsed by the GOLD guidelines as a first-line maintenance therapy for COPD patients with a history of exacerbations. However, there is a lack of randomized clinical trials comparing exacerbation rates among COPD patients receiving budesonide/formoterol combination (BFC) and fluticasone/salmeterol combination (FSC).
To compare the effectiveness of BFC and FSC treatments in COPD patients who just started ICS/LABA combination treatment in a population of US managed care enrollees, David M Kern from HealthCore, Inc and his colleagues from AstraZeneca Pharmaceuticals evaluated patients with COPD naive to ICS/LABA who started BFC or FSC treatments between 2009 and 2012. Patients were identified in the US managed care database and were followed for 12 months. They were then matched 1-to-1 on demographic and pre-initiation clinical characteristics using propensity scores.
The study’s primary efficacy endpoint was COPD exacerbation rate, and the secondary efficacy endpoints were the exacerbation rates by event type and healthcare resource utilization. Pneumonia objectives included rates of any diagnosis of pneumonia and pneumonia-related healthcare utilization resource.
Matching of the identified 3,788 BFC and 6,439 FSC patients resulted in 3,697 patients in each of the study groups.
The results revealed no differences between patients initiating BFC or FSC in a real-world setting in terms of rates of exacerbations, measured by COPD-related inpatient hospitalizations, emergency department visits, and outpatient visits with antibiotic/OCS medication use.
This finding was consistent across all sensitivity analyses and secondary endpoints. Pneumonia rates during the first year of initiating the therapy were also similar between the two groups, with similar rates of healthcare resource utilization and respiratory medication use.
The study is titled “Comparative effectiveness of budesonide/formoterol combination and fluticasone/salmeterol combination among chronic obstructive pulmonary disease patients new to controller treatment: a US administrative claims database study.”