| アブストラクト | Respiratory societies now advocate for long-acting beta(2)-agonist (LABA) and long-acting muscarinic antagonist (LAMA) combinations (LABA-LAMA) as initial pharmacological treatment of COPD patients with multiple exacerbations or significant symptoms. However, the evidence comes from trials involving treatment-experienced patients. We identified a cohort of newly diagnosed COPD patients, 40 years of age or older, from the UK's Clinical Practice Research Datalink over 2014-2021. Treatment-naive initiators of single-inhaler LABA-LAMA or LAMA were compared on the incidence of COPD exacerbation and major adverse cardiovascular events (MACE) over one year, after adjustment by propensity score weighting. The cohort included 16,804 initiators of LABA-LAMA and 57,295 of LAMA. The adjusted hazard ratio (HR) of a first moderate or severe exacerbation with LABA-LAMA relative to LAMA was 1.00 (95% confidence interval (CI): 0.96-1.05). This HR was 0.93 (95% CI: 0.86-1.00) among GOLD group E patients, 1.07 (95% CI: 0.99-1.15) among GOLD group B patients, and 0.91 (95% CI: 0.83-0.99) for patients with FEV(1) < 50% predicted. The HR of MACE was 1.13 (95% CI: 1.02-1.25) overall and 1.03 (95% CI: 0.83-1.28) among patients with FEV(1) < 50% predicted. In a real-world clinical practice setting of COPD treatment, initiating therapy with LABA-LAMA may be more effective at exacerbation reduction than LAMA among patients with multiple exacerbations and those with FEV(1)<50% predicted. The small increase in MACE risk with LABA-LAMA should be considered when initiating bronchodilator therapy in newly diagnosed COPD, particularly those with FEV(1)>/=50% predicted. This study supports a targeted approach to initial COPD therapy. |
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| ジャーナル名 | COPD |
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| Pubmed追加日 | 2026/2/19 |
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| 投稿者 | Suissa, Samy; Cherian, Mathew; Dell'Aniello, Sophie; Ernst, Pierre |
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| 組織名 | Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital,;Montreal, Quebec, Canada.;Department of Epidemiology, Biostatistics and Occupational Health, McGill;University, 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/41709817/ |
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