COPD: LAMA-LABA-ICS linked to more pneumonias than LAMA-LABA

  • Suissa S & al.
  • Chest
  • 1 Jun 2019

  • International Clinical Digest
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Takeaway

  • In a large real-world cohort of patients with COPD in primary care, initiation of triple-combination therapy (long-acting muscarinic antagonist [LAMA]+long-acting beta2-agonist [LABA]+inhaled corticosteroid [ICS]) had some upsides over LAMA-LABA alone, but also had nearly 50% more severe pneumonias.

Why this matters

  • This is one of the first studies to quantify the risk for severe pneumonias in a real-world cohort.
  • Findings suggest that LAMA-LABA is preferable to triple therapy for most patients except those with high eosinophils and ≥2 prior exacerbations.

Study design

  • Real-world observational cohort of triple-combination (n=6921) and LAMA-LABA (n=1932) therapy initiated in older primary care patients (≥55 years; 2002-2015) in the UK Clinical Practice Research Datalink.
  • Funding: Canadian Institutes of Health Research; Canadian Foundation for Innovation; Boehringer-Ingelheim.

Key results

  • No difference between triple therapy and LAMA-LABA in the incidence during a year of moderate or severe COPD exacerbations (adjusted HR, 0.97; 95% CI, 0.87-1.08).
    • Triple therapy was better for the subgroup with blood eosinophils >6% (HR, 0.66; 95% CI, 0.46-0.94) and for the subgroup with ≥2 prior exacerbations (HR, 0.83; 95% CI, 0.70-0.98).
  • Triple therapy had a nearly 50% greater likelihood of severe pneumonia requiring hospitalisation (HR, 1.46; 95% CI, 1.03-2.06).

Limitations

  • Observational design.