The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD: a UK database study
dc.contributor.author | Jones, Rupert | |
dc.contributor.author | Martin, J | |
dc.contributor.author | Thomas, V | |
dc.contributor.author | Skinner, D | |
dc.contributor.author | Marshall, J | |
dc.contributor.author | Stagno d'Alcontres, M | |
dc.contributor.author | Price, D | |
dc.date.accessioned | 2018-01-02T13:22:34Z | |
dc.date.available | 2018-01-02T13:22:34Z | |
dc.date.issued | 2017-08-17 | |
dc.identifier.issn | 1178-2005 | |
dc.identifier.issn | 1178-2005 | |
dc.identifier.uri | http://hdl.handle.net/10026.1/10467 | |
dc.description.abstract |
Chronic obstructive pulmonary disease (COPD), a complex progressive disease, is currently the third leading cause of death worldwide. One recommended treatment option is fixed-dose combination therapy of an inhaled corticosteroid (ICS)/long-acting β-agonist. Clinical trials suggest pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) show similar efficacy and safety profiles in COPD. Real-world observational studies have shown that combination therapy has significantly greater odds of achieving asthma control when delivered via pMDIs. Our aim was to compare effectiveness, in terms of moderate/severe COPD exacerbations and long-acting muscarinic antagonist (LAMA) prescriptions, for COPD patients initiating fluticasone propionate (FP)/salmeterol xinafoate (SAL) via pMDI versus DPI at two doses of FP (500 and 1,000 μg/d) using a real-life, historical matched cohort study. COPD patients with ≥2 years continuous practice data, ≥2 prescriptions for FP/SAL via pMDI/DPI, and no prescription for ICS were selected from the Optimum Patient Care Research Database. Patients were matched 1:1. Rate of moderate/severe COPD exacerbations and odds of LAMA prescription were analyzed using conditional Poisson and logistic regression, respectively. Of 472 patients on 500 μg/d, we observed fewer moderate/severe exacerbations in patients using pMDI (99 [42%]) versus DPI (115 [49%]) (adjusted rate ratio: 0.71; 95% confidence interval: 0.54, 0.93), an important result since the pMDI is not licensed for COPD in the UK, USA, or China. At 1,000 μg/d, we observed lower LAMA prescription for pMDI (adjusted odds ratio: 0.71; 95% confidence interval: 0.55, 0.91), but no difference in exacerbation rates, potentially due to higher dose of ICS overcoming low lung delivery from the DPI. | |
dc.format.extent | 2445-2454 | |
dc.format.medium | Electronic-eCollection | |
dc.language | en | |
dc.language.iso | en | |
dc.publisher | Dove Medical Press | |
dc.subject | COPD | |
dc.subject | inhaler type | |
dc.subject | exacerbations | |
dc.subject | pneumonia | |
dc.subject | diabetes | |
dc.subject | dose-response | |
dc.subject | inhaled steroid/LABA combination | |
dc.title | The comparative effectiveness of initiating fluticasone/salmeterol combination therapy via pMDI versus DPI in reducing exacerbations and treatment escalation in COPD: a UK database study | |
dc.type | journal-article | |
dc.type | Comparative Study | |
dc.type | Journal Article | |
dc.type | Observational Study | |
plymouth.author-url | https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000407792000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008 | |
plymouth.volume | Volume 12 | |
plymouth.publication-status | Published | |
plymouth.journal | International Journal of Chronic Obstructive Pulmonary Disease | |
dc.identifier.doi | 10.2147/COPD.S141409 | |
plymouth.organisational-group | /Plymouth | |
plymouth.organisational-group | /Plymouth/Faculty of Health | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy MANUAL | |
plymouth.organisational-group | /Plymouth/Research Groups | |
plymouth.organisational-group | /Plymouth/Research Groups/FoH - Community and Primary Care | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Health and Community | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED) | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS | |
plymouth.organisational-group | /Plymouth/Users by role | |
dc.publisher.place | New Zealand | |
dcterms.dateAccepted | 2017-07-05 | |
dc.identifier.eissn | 1178-2005 | |
dc.rights.embargoperiod | Not known | |
rioxxterms.versionofrecord | 10.2147/COPD.S141409 | |
rioxxterms.licenseref.uri | http://www.rioxx.net/licenses/all-rights-reserved | |
rioxxterms.licenseref.startdate | 2017-08-17 | |
rioxxterms.type | Journal Article/Review |