When used alone, long-acting muscarinic antagonists (LAMAs) and long-acting beta-2 agonists (LABAs) showed similar cardiovascular and cerebrovascular safety, a new retrospective cohort study has found. Findings are published inPharmacotherapy.

Researchers compared the risk of cardiovascular and cerebrovascular events among patients with chronic obstructive pulmonary disease (COPD) that were treated with long-acting bronchodilator monotherapy or combination therapy. They reviewed a population-based healthcare database from Taiwan for patients with COPD who initiated LAMAs alone, LABAs alone, and LABA + LAMA combination between 2001–2010. 

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The study compared a composite cardiovascular outcome, defined as hospitalization for acute myocardial infarction, congestive heart failure, and cerebrovascular diseases among 3 treatment groups, adjusting for potential confounding variables. Of the eligible 2,458 patients, there were 505 composite cardiovascular events identified during the 10,590 patient-years of follow-up. The primary analysis showed LABA alone and LAMA alone were associated with similar risks of the composite outcome (hazard ratio [HR] 1.09, 95% CI: 0.87–1.37). When comparing LABA + LAMA combination to LAMA alone, the HR was 1.13 (95% CI: 0.60–2.13), and when compared to LABA alone, the HR was 1.03 (95% CI: 0.55–1.92). 

A secondary analysis where patients were allowed to re-enter the cohort upon treatment change showed slightly elevated HR values when LABA + LAMA was compared to LAMA alone (HR 1.26, 95% CI: 0.74-2.15) and to LABA alone (HR 1.31, 95% CI: 0.80–2.13).

Study authors noted that more studies are necessary to exclude potential risk associated with inhaled long-acting bronchodilator combination therapy.

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