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Combination therapy with long-acting beta-agonists plus inhaled corticosteroids is superior to long-acting beta-agonists alone in older patients with COPD, especially those who also have asthma, according to a report published online Sept. 16 in JAMA.
The combination therapy has proved superior in clinical trials, but those studies excluded older patients, patients with comorbidities (especially asthma), and patients taking long-acting anticholinergic medications. To compare the two treatment approaches in a real world setting, researchers performed a retrospective observational study involving 38,266 Ontario residents (aged 66 and older) who were diagnosed as having COPD and who initiated therapy during an 8-year period.
A total of 8,712 of these adults who were new users of combination long-acting beta-agonists plus corticosteroids were propensity matched with 3,160 who were new users of long-acting beta-agonists alone. The mean age of these participants was 77 years, and they had a median of seven comorbid diseases; 28% had comorbid asthma. These study participants were followed for up to 5 years, with a median follow-up of 2.6 years, said Dr. Andrea S. Gershon of the Institute for Clinical Evaluative Sciences, Toronto, and her associates.
The primary study outcome, a composite of all-cause mortality and COPD-related hospitalization, occurred in 64% of patients in the combination-therapy group, which was a “modest but significantly lower” rate than in the single-therapy group (67%). This small but significant difference persisted when mortality and hospitalizations were analyzed separately. Two subgroups of patients showed even greater benefit from the combination therapy: those with concomitant asthma, and those who were not taking long-acting anticholinergics for their COPD, the investigators reported (JAMA 2014 Sept. 16 [doi:10.1001/jama.2014.11432]).
This study was supported by Physicians’ Services Incorporated Foundation; the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes; the University of Toronto; the Institute for Clinical Evaluative Sciences; and the Ontario Ministry of Health and Long-Term Care. Dr. Gershon and her associates reported no relevant financial conflicts.
Perhaps the most noteworthy finding of Dr. Gershon and her associates is that the combination therapy proved to be more effective, even though the study participants were much different from those in whom this treatment was validated in randomized clinical trials.
Clinical outcomes in these real world patients were better than might have been expected, even though they were older, much more diverse, and often sicker than the patients in the clinical trials.
Dr. Peter M.A. Calverley is at the Institute of Ageing and Chronic Disease at the University of Liverpool (England). He made these remarks in an editorial accompanying Dr. Gershon’s report (JAMA 2014;312:1101-2). Dr. Calverley reported ties to GlaxoSmithKline, Boehringer Ingelheim, Takeda, Novartis, and Astra Zeneca.
Perhaps the most noteworthy finding of Dr. Gershon and her associates is that the combination therapy proved to be more effective, even though the study participants were much different from those in whom this treatment was validated in randomized clinical trials.
Clinical outcomes in these real world patients were better than might have been expected, even though they were older, much more diverse, and often sicker than the patients in the clinical trials.
Dr. Peter M.A. Calverley is at the Institute of Ageing and Chronic Disease at the University of Liverpool (England). He made these remarks in an editorial accompanying Dr. Gershon’s report (JAMA 2014;312:1101-2). Dr. Calverley reported ties to GlaxoSmithKline, Boehringer Ingelheim, Takeda, Novartis, and Astra Zeneca.
Perhaps the most noteworthy finding of Dr. Gershon and her associates is that the combination therapy proved to be more effective, even though the study participants were much different from those in whom this treatment was validated in randomized clinical trials.
Clinical outcomes in these real world patients were better than might have been expected, even though they were older, much more diverse, and often sicker than the patients in the clinical trials.
Dr. Peter M.A. Calverley is at the Institute of Ageing and Chronic Disease at the University of Liverpool (England). He made these remarks in an editorial accompanying Dr. Gershon’s report (JAMA 2014;312:1101-2). Dr. Calverley reported ties to GlaxoSmithKline, Boehringer Ingelheim, Takeda, Novartis, and Astra Zeneca.
Combination therapy with long-acting beta-agonists plus inhaled corticosteroids is superior to long-acting beta-agonists alone in older patients with COPD, especially those who also have asthma, according to a report published online Sept. 16 in JAMA.
The combination therapy has proved superior in clinical trials, but those studies excluded older patients, patients with comorbidities (especially asthma), and patients taking long-acting anticholinergic medications. To compare the two treatment approaches in a real world setting, researchers performed a retrospective observational study involving 38,266 Ontario residents (aged 66 and older) who were diagnosed as having COPD and who initiated therapy during an 8-year period.
A total of 8,712 of these adults who were new users of combination long-acting beta-agonists plus corticosteroids were propensity matched with 3,160 who were new users of long-acting beta-agonists alone. The mean age of these participants was 77 years, and they had a median of seven comorbid diseases; 28% had comorbid asthma. These study participants were followed for up to 5 years, with a median follow-up of 2.6 years, said Dr. Andrea S. Gershon of the Institute for Clinical Evaluative Sciences, Toronto, and her associates.
The primary study outcome, a composite of all-cause mortality and COPD-related hospitalization, occurred in 64% of patients in the combination-therapy group, which was a “modest but significantly lower” rate than in the single-therapy group (67%). This small but significant difference persisted when mortality and hospitalizations were analyzed separately. Two subgroups of patients showed even greater benefit from the combination therapy: those with concomitant asthma, and those who were not taking long-acting anticholinergics for their COPD, the investigators reported (JAMA 2014 Sept. 16 [doi:10.1001/jama.2014.11432]).
This study was supported by Physicians’ Services Incorporated Foundation; the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes; the University of Toronto; the Institute for Clinical Evaluative Sciences; and the Ontario Ministry of Health and Long-Term Care. Dr. Gershon and her associates reported no relevant financial conflicts.
Combination therapy with long-acting beta-agonists plus inhaled corticosteroids is superior to long-acting beta-agonists alone in older patients with COPD, especially those who also have asthma, according to a report published online Sept. 16 in JAMA.
The combination therapy has proved superior in clinical trials, but those studies excluded older patients, patients with comorbidities (especially asthma), and patients taking long-acting anticholinergic medications. To compare the two treatment approaches in a real world setting, researchers performed a retrospective observational study involving 38,266 Ontario residents (aged 66 and older) who were diagnosed as having COPD and who initiated therapy during an 8-year period.
A total of 8,712 of these adults who were new users of combination long-acting beta-agonists plus corticosteroids were propensity matched with 3,160 who were new users of long-acting beta-agonists alone. The mean age of these participants was 77 years, and they had a median of seven comorbid diseases; 28% had comorbid asthma. These study participants were followed for up to 5 years, with a median follow-up of 2.6 years, said Dr. Andrea S. Gershon of the Institute for Clinical Evaluative Sciences, Toronto, and her associates.
The primary study outcome, a composite of all-cause mortality and COPD-related hospitalization, occurred in 64% of patients in the combination-therapy group, which was a “modest but significantly lower” rate than in the single-therapy group (67%). This small but significant difference persisted when mortality and hospitalizations were analyzed separately. Two subgroups of patients showed even greater benefit from the combination therapy: those with concomitant asthma, and those who were not taking long-acting anticholinergics for their COPD, the investigators reported (JAMA 2014 Sept. 16 [doi:10.1001/jama.2014.11432]).
This study was supported by Physicians’ Services Incorporated Foundation; the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes; the University of Toronto; the Institute for Clinical Evaluative Sciences; and the Ontario Ministry of Health and Long-Term Care. Dr. Gershon and her associates reported no relevant financial conflicts.
FROM JAMA
Key clinical point: Combination therapy with long-acting beta-agonists plus inhaled corticosteroids should be considered for older patients with COPD.Major finding: The primary study outcome, a composite of all-cause mortality and COPD-related hospitalization, occurred in 64% of patients in the combination-therapy group, which was a “modest but significantly lower” rate than in the single-therapy group (67%).
Data source: A retrospective observational cohort study of elderly COPD patients comparing outcomes between 8,712 who took combination therapy and 3,160 who took single therapy, who were followed for up to 5 years.
Disclosures: This study was supported by Physicians’ Services Incorporated Foundation; the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes; the University of Toronto; the Institute for Clinical Evaluative Sciences; and the Ontario Ministry of Health and Long-Term Care. Dr. Gershon and her associates reported no relevant financial conflicts.