| アブストラクト | BACKGROUND: The 2023 Global initiative for chronic Obstructive Lung Disease (GOLD) recommendations advocate long-acting beta(2) agonist (LABA) and long-acting muscarinic antagonist (LAMA) combinations (LABA-LAMA) for the initial pharmacological treatment of patients with chronic obstructive pulmonary disease (COPD) with multiple exacerbations. However, this choice, rather than combinations of LABA and inhaled corticosteroids (LABA-ICS), no longer recommended in GOLD, was based on randomised trials that excluded patients with multiple prior exacerbations. RESEARCH QUESTION: What is the comparative effectiveness of initiating COPD treatment with LABA-ICS versus LABA-LAMA inhalers, particularly in patients with multiple COPD exacerbations, in a real-world clinical practice setting? STUDY DESIGN AND METHODS: We identified a cohort of patients with COPD, 40 years of age or older, from the United Kingdom's Clinical Practice Research Datalink. Treatment-naive initiators of single-inhaler LABA-ICS or LABA-LAMA, with no prior asthma, LABA, LAMA or ICS use, were compared on the incidence of moderate or severe COPD exacerbation over 1 year, after adjustment by propensity score weighting. RESULTS: The study cohort included 20 750 initiators of LABA-ICS inhalers and 16 594 of LABA-LAMA. The overall adjusted HR of a first moderate or severe exacerbation with LABA-ICS relative to LABA-LAMA was 1.03 (95% CI 0.98 to 1.08). Among patients with two or more prior exacerbations, the HR of exacerbation with LABA-ICS versus LABA-LAMA was 0.89 (95% CI 0.81 to 0.97), while it was 1.07 (95% CI 1.00 to 1.15) among patients with no prior exacerbations. The HR was 0.92 (95% CI 0.86 to 0.99) among those with forced expiratory volume in 1 s (FEV(1))>/=50% predicted. INTERPRETATION: In a real-world clinical practice setting of COPD treatment, initiating therapy with LABA-ICS inhalers may be more effective than LABA-LAMA inhalers among patients with multiple exacerbations, particularly those with FEV(1)>/=50% predicted, but less effective among those with no prior exacerbations and FEV(1)<50% predicted. This study supports a targeted approach to initial therapy for COPD. . |
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| ジャーナル名 | BMJ open respiratory research |
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| Pubmed追加日 | 2025/12/20 |
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| 投稿者 | Suissa, Samy; Cherian, Mathew; Dell'Aniello, Sophie; Ernst, Pierre |
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| 組織名 | Department of Epidemiology, Biostatistics and Medicine, McGill University,;Montreal, Quebec, Canada samy.suissa@mcgill.ca.;Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec,;Canada.;Department of Medicine, McGill University, Montreal, Quebec, Canada. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/41419233/ |
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