Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Arch Bronconeumol. 2022 Oct;58(10):699-707. doi: 10.1016/j.arbres.2022.05.002. Epub 2022 May 13.
Initiation of treatment of COPD with a combination of a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS) is frequent irrespective of the risk of exacerbations.
We performed a retrospective, population-based, observational study aimed at comparing the effectiveness of a LABA/long-acting antimuscarinic agent (LAMA) and LABA/ICS in patients with COPD over a one-year follow-up. Data were obtained from an administrative healthcare claims database. The primary outcome was the risk of first exacerbation. A sensitivity analysis was conducted in a propensity-score matched population.
The population consisted of 14,046 COPD patients; 11,329 (80.6%) initiated LABA/ICS and 2717 (19.4%) LABA/LAMA. The matched population included 1650 patients in each arm. During follow-up, 69.6% patients in the LABA/ICS group and 64.4% in the LABA/LAMA group presented an exacerbation. The mean time to the first exacerbation was 6.03 months (95% confidence interval (CI): 5.94-6.12) for LABA/ICS and 6.4 months (95%CI: 6.21-6.59) for LABA/LAMA; p<0.001. The time to scalation to triple therapy was also significantly prolonged in LABA/LAMA. Similar results were obtained in the matched population. LABA/LAMA was associated with a significantly lower risk of exacerbations and escalation to triple therapy compared to LABA/ICS, except in patients with frequent exacerbations and high blood eosinophils in which no differences were observed in the time to first exacerbation.
Initiation of treatment with LABA/LAMA was associated with a lower risk of exacerbation and escalation to triple therapy compared to LABA/ICS in the majority of patients with COPD in primary care.
无论加重风险如何，启动 COPD 的治疗时联合使用长效β激动剂（LABA）和吸入性皮质类固醇（ICS）都是常见的。
我们进行了一项回顾性、基于人群的观察性研究，旨在比较 LABA/长效抗毒蕈碱剂（LAMA）和 LABA/ICS 在 COPD 患者中的有效性，随访时间为一年。数据来自行政医疗保健索赔数据库。主要结局是首次加重的风险。在倾向评分匹配人群中进行了敏感性分析。
该人群包括 14046 例 COPD 患者；11329 例（80.6%）起始 LABA/ICS，2717 例（19.4%）起始 LABA/LAMA。匹配人群中每组各包括 1650 例患者。在随访期间，LABA/ICS 组中 69.6%的患者和 LABA/LAMA 组中 64.4%的患者发生加重。首次加重的平均时间为 LABA/ICS 组 6.03 个月（95%置信区间[CI]：5.94-6.12）和 LABA/LAMA 组 6.4 个月（95%CI：6.21-6.59）；p<0.001。LABA/LAMA 组升级为三联疗法的时间也明显延长。匹配人群中也得到了类似的结果。与 LABA/ICS 相比，LABA/LAMA 与加重风险和升级为三联疗法的风险显著降低相关，但在频繁加重和血嗜酸性粒细胞高的患者中，首次加重的时间无差异。
在初级保健中，大多数 COPD 患者中，起始 LABA/LAMA 治疗与 LABA/ICS 相比，加重和升级为三联疗法的风险较低。
