Fluticasone-Based versus Budesonide-Based Triple Therapies in COPD: Real-World Comparative Effectiveness and Safety.
COPD
; 19(1): 109-117, 2022.
Article
em En
| MEDLINE
| ID: mdl-35385359
ABSTRACT
Triple therapy for chronic obstructive pulmonary disease (COPD) is recommended for some patients, but the inhaled corticosteroids (ICS) may differ in effectiveness and safety. We compared budesonide-based and fluticasone-based triple therapy given in two inhalers on the incidence of exacerbation, mortality and severe pneumonia, using an observational study approach. We identified a cohort of patients with COPD, new users of triple therapy given in two inhalers during 2002-2018, age 50 or older, from the UK's CPRD database, and followed for one year. The hazard ratio (HR) of exacerbation, all-cause death and pneumonia was estimated using the Cox regression model, weighted by fine stratification of the propensity score of treatment initiation. The cohort included 29,716 new users of fluticasone-based triple therapy and 9,646 of budesonide-based. The HR of a first moderate or severe exacerbation with budesonide-based triple therapy was 0.98 (95% CI 0.94-1.03), relative to fluticasone-based, while for a severe exacerbation it was 0.97 (95% CI 0.87-1.07). The incidence of all-cause death was lower with budesonide-based therapy among patients with no prior exacerbations (HR 0.80; 95% CI 0.66-0.98). The HR of severe pneumonia with budesonide-based therapy was 0.84 (95% CI 0.75-0.95). In a real-world clinical setting of COPD treatment, budesonide-based triple therapy given in two inhalers was generally as effective at reducing exacerbations as fluticasone-based triple therapy. However, the budesonide-based triple therapy was associated with a lower incidence of severe pneumonia and possibly also of all-cause death, especially among patients with no prior exacerbations for whom triple therapy is not recommended.
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Base de dados:
MEDLINE
Assunto principal:
Pneumonia
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Doença Pulmonar Obstrutiva Crônica
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
Limite:
Humans
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Middle aged
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article