Treatment with a long-acting beta2-agonist (LABA) in combination with a long-acting muscarinic agonist (LAMA) was found to be as effective as combination therapy with LABA plus inhaled corticosteroid (ICS), as measured by exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). These are the findings of a new study published online in the journal Pharmacotherapy.

Clinical guidelines currently recommend LABA/LAMA therapy as an alternative to LABA/ICS but evidence on the comparative effectiveness of these combination therapies for COPD is limited. In order to compare real-world COPD outcomes, researchers conducted a retrospective, observational study of COPD patients treated with LABA/LAMA or LABA/ICS from January 2004 to December 2014. To be included in the study, patients were required to fill more than one prescription for a combination medication; they were followed for 30 days after starting therapy.

Five thousand three hundred and eighty-four patients were included in the LABA/LAMA cohort; this group was older, had more severe COPD, and had more comorbidities. The LABA/ICS cohort included 473,388 patients. Poisson regression was used to compare exacerbation rates.

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In the LABA/LAMA group the unadjusted annual exacerbation rate was 2.87 events/person with the LABA/ICS cohort having an annual exacerbation rate of 1.68. The adjusted incidence rate ratio for LABA/LAMA compared to LABA/ICS was 0.98 (95% CI: 0.95–1.01).

Given that exacerbation rates were similar between these two combination therapies, the authors conclude that “characteristics other than effectiveness – such as symptom control, cost, patient preferences, and adverse events – may be important in selecting between the two regimens.”

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