J Clin Outcomes Manage
Effectiveness of inhaled combined corticosteroid/long acting bronchodilator treatment in reducing COPD exacerbations and short-acting bronchodilator use
Mapel D, Roberts MH, Blanchette CM, Petersen H, Ramachandran S
ABSTRACT Objective: To compare budesonide/formoterol (BFC) and fluticasone propionate/salmeterol (FSC) in their ability to reduce COPD exacerbations using a novel risk stratification approach. Design: Retrospective cohort study with propensity matching and stratification by short-acting beta2-agonist (SABA) use. Participants: 7704 COPD patients identified using 2 U.S. health claims databases (study period: 1/1/2004 to 4/30/2009). Measurements: Users of BFC and FSC were stratified by SABA fills in the 6 months prior to the start of therapy (index date). Exacerbation events before and after the index date were compared, and proportional hazard models used to examine exacerbation risk by baseline SABA use. Results: At baseline, 6% (6.2%, BFC; 5.8%, FSC) had a COPD-related hospitalization or emergency department (ED) visit. Post-index, this was reduced to 4.8% (P < 0.001) among all patients (4.9%, BFC, 4.7%, FSC). Change was greatest among high SABA users (9% pre-index to 4.9% post-index, P < 0.001). SABA use post-index was reduced in both groups, with slightly lower need for SABA refills seen among BFC users. SABA use was correlated with increased exacerbations during the baseline period and was predictive of exacerbations during the follow-up period. Conclusions: BFC and FSC had equivalent effectiveness in reduction in ED visits and hospitalizations for COPD exacerbations, but BFC users had lower subsequent need for SABA fills. Increased SABA use is a predictor of COPD exacerbation among COPD patients in the general population.
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