COPD: umeclidinium/vilanterol vs fluticasone propionate/salmeterol as initial maintenance therapy

  • Moretz C & al.
  • Int J Chron Obstruct Pulmon Dis
  • 1 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with chronic obstructive pulmonary disease (COPD), the initiation of maintenance therapy with umeclidinium/vilanterol (UMEC/VI) was associated with significantly better medication adherence and slower escalation to multiple-inhaler triple therapy compared with fluticasone propionate/salmeterol (FP/SAL).

Why this matters

  • Findings suggest that, compared with FP/SAL, initiating maintenance therapy with UMEC/VI may have a positive impact on patient outcomes.

Study design

  • Retrospective observational study included 5306 patients with COPD who initiated UMEC/VI (62.5/25 μg; n=1386) and FP/SAL (250/50 μg; n=3920) between April 2014 and August 2016 (index date).
  • Primary outcome: medication adherence (the proportion of days covered ≥80%).
  • Secondary outcomes: incidence of first exacerbation (moderate/severe), first severe exacerbation and escalation to multiple-inhaler triple therapy in intent-to-treat analyses.
  • Funding: GSK.

Key results

  • After adjustment for confounders, UMEC/VI vs FP/SAL initiators had greater medication adherence (OR, 2.00; 95% CI, 1.62-2.46; P<.001>
  • UMEC/VI vs FP/SAL initiators did not differ in the risk for first moderate/severe (adjusted HR [aHR], 0.87; 95% CI, 0.74-1.01; P=.067) and severe (aHR, 0.83; 95% CI, 0.53-1.30; P=.418) exacerbations.
  • The risk for escalation to multiple-inhaler triple therapy was significantly lower in UMEC/VI vs FP/SAL (aHR, 0.65; 95% CI, 0.47-0.89; P=.008).
  • On-treatment sensitivity analysis, UMEC/VI initiators had lower risk for first moderate/severe COPD exacerbation vs FP/SAL initiators (aHR, 0.70; 95% CI, 0.54-0.90; P=.006).

Limitations

  • Retrospective design.