Comparative Effects of LAMA-LABA-ICS vs LAMA-LABA for COPD Cohort Study in Real-World Clinical Practice
Comparative Effects of LAMA-LABA-ICS vs LAMA-LABA for COPD Cohort Study in Real-World Clinical Practice
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DOI：
10.1016/j.chest.2019.11.007
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发表时间：
2020-04-01
期刊：
影响因子：
9.6
通讯作者：
Ernst, Pierre
中科院分区：
文献类型：
--
作者：
Suissa, Samy;Dell'Aniello, Sophie;Ernst, Pierre
背景资料。在随机试验和观察性研究中，对长效M受体拮抗剂(LAMA)、长效β(2)-激动剂(LABA)和吸入性皮质类固醇(ICS)治疗COPD的三联疗法进行了研究，结果各不相同。我们在现实世界的临床实践环境中比较了三联疗法和LAMA-LABA联合疗法的有效性和安全性。方法：我们从英国临床实践研究数据链中确定了2002-2015年间年龄为55岁的COPD患者队列。启动LAMA-LABA-ICS的患者在时间条件倾向评分上与启动LAMA-LABA的患者进行了4：1的匹配，并对中、重度COPD恶化和严重肺炎的发生进行了为期1年的跟踪调查。结果：队列包括6921名LAMA-LABA-ICS发起者和1,932名LAMA-LABA发起者。LAMA-LABA-ICS方案与LAMA-LABA方案相比，COPD恶化的调整危险比(HR)为0.97(95%CI，0.87-1.08)。对于嗜酸性粒细胞计数<6%的患者，HR为0.66(95%CI，0.46-0.94)。对于有两次或两次以上病情加重的患者，这一比例为0.83(95%CI，0.70-0.98)。随着LAMA-LABAICS的启动，需要住院治疗的重症肺炎的发生率增加(HR，1.46；95%CI，1.03-2.06)。结论在COPD治疗的实际环境中，LAMA、LABA和ICS吸入器的三联用在预防COPD恶化方面通常与LAMA和LABA吸入器的组合一样有效。然而，除了有明显的嗜酸性粒细胞增多症或频繁加重的患者外，LAMA-LABA联合应用无ICS可能更可取，因为它与较少的重症肺炎有关。
BACKGROUND. Triple therapy combinations of a long-acting muscarinic antagonist (LAMA), a long-acting beta(2)-agonist (LABA), and an inhaled corticosteroid (ICS) for COPD were studied in randomized trials and observational studies, with variable results. We compared the effectiveness and safety of triple therapy with a LAMA-LABA combination in a realworld clinical practice setting.METHODS: We identified a cohort of patients with COPD during 2002 through 2015, >= 55 years of age, from the UK's Clinical Practice Research Datalink. Patients initiating LAMA-LABA-ICS were matched 4:1 on time-conditional propensity scores with patients initiating LAMA-LABA, and followed for 1 year for the occurrence of a moderate or severe COPD exacerbation and severe pneumonia.RESULTS: The cohort included 6,921 initiators of LAMA-LABA-ICS matched to 1,932 initiators of LAMA-LABA. The adjusted hazard ratio (HR) of a COPD exacerbation associated with LAMA-LABA-ICS initiation compared with LAMA-LABA initiation was 0.97 (95% CI, 0.87-1.08). For patients with blood eosinophil counts > 6%, the HR was 0.66 (95% CI, 0.46-0.94). For patients with two or more prior exacerbations, it was 0.83 (95% CI, 0.70-0.98). The incidence of severe pneumonia requiring hospitalization was increased with LAMA-LABAICS initiation (HR, 1.46; 95% CI, 1.03-2.06).CONCLUSIONS In a real-world setting of COPD treatment, the triple combination of LAMA, LABA, and ICS inhalers is generally as effective as combining LAMA and LABA inhalers in preventing COPD exacerbations. However, with the possible exception of patients with significant eosinophilia or frequent exacerbators, a LAMA-LABA combination without ICS may be preferable because it is associated with fewer severe cases of pneumonia.