| アブストラクト | BACKGROUND: Recent treatment guidelines for chronic obstructive pulmonary disease (COPD) have replaced the long-acting beta(2)-agonist and inhaled corticosteroid (LABA-ICS) combination with single-inhaler triple therapy that adds a long-acting muscarinic antagonist (LAMA-LABA-ICS). Yet, the corresponding trials reported numerically higher incidences of cardiovascular adverse events with triple therapy compared with LABA-ICS. RESEARCH QUESTION: Does single-inhaler triple therapy increase the incidence of major adverse cardiovascular events, compared with LABA-ICS, in a real-world clinical practice setting? STUDY DESIGN AND METHODS: We identified a cohort of COPD patients, 40 years or older, treated during 2017-2021, from the United Kingdom's Clinical Practice Research Datalink. Among LAMA-naive patients, initiators of single-inhaler triple therapy were matched 1:1 to LABA-ICS users on time-conditional propensity scores. They were compared on the incidence of major adverse cardiovascular events (MACE), defined as hospitalization for myocardial infarction or stroke, or all-cause-mortality, over one year. RESULTS: The cohort included 10,255 initiators of triple therapy and 10,255 matched users of LABA-ICS. The incidence rate of MACE was 11.3 per 100 per year with triple therapy compared with 8.7 per 100 per year for LABA-ICS. The corresponding adjusted hazard ratio (HR) of MACE with triple therapy was 1.28 (95% CI: 1.05-1.55), relative to LABA-ICS, though the increase was mainly in the first four months (HR 1.41; 95%CI: 1.14-1.74). The HR of all-cause death was 1.31 (95% CI: 1.06-1.62), while for acute myocardial infarction and stroke hospitalization it was 1.00 (95% CI: 0.56-1.79) and 1.06 (95% CI: 0.48-2.36), respectively, with triple therapy, relative to LABA-ICS. INTERPRETATION: In a real-world setting of COPD treatment, patients who initiated single-inhaler triple therapy had an increased incidence of MACE compared with similar patients treated with a LABA-ICS inhaler. This small increase was due to the all-cause mortality component, occurring mainly in the first four months after treatment initiation. |
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| ジャーナル名 | Chest |
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| Pubmed追加日 | 2024/10/27 |
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| 投稿者 | Suissa, Samy; 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. Electronic address:;samy.suissa@mcgill.ca.;Montreal, Quebec, Canada.;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/39461554/ |
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