Compare initial hospitalization risk of various COPD treatments using a retrospective observational study.
Patients ≥ 45 years enrolled in 24 different managed care plans across the US during 1997–2000 with a primary diagnosis of COPD (ICD-9-CM = 491, 492, 496), were identified. Subjects were followed for 12 months following the initial prescription for COPD treatment. Five therapy cohorts were identified: 1) ipratropium/albuterol (IPR), 2) salmeterol (SAL), 3) inhaled corticosteroid (ICS), 4) ICS + IPR, and 5) ICS + SAL. Patients were excluded from the analysis if they received other treatments for COPD; cromolyn, theophylline and leukotriene modifiers or had a COPD hospitalization, 12-months prior to the initial prescription. Cox proportional hazard analysis on time to first COPD hospitalization was perfromed comparing all the cohorts to IPR adjusting for age, gender, concomitant asthma, other respiratory disorders, health plan, baseline oral steroid, albuterol use and physician specialty.
3616 patients were identified, 1071 on IPR, 1032 on ICS, 357 on ICS + IPR, 266 on SAL and 207 on ICS + SAL. Compared with IPR alone, ICS + SAL had a 78% lower COPD hospitalization risk (HR 0.22, 95% CI 0.11, 0.44). In addition, ICS + IPR and ICS alone had a 42%, (HR 0.58, 95% CI 0.41, 0.82) and 37% (HR 0.63, 95% CI 0.50, 0.79) lower risk respectively. SAL was had a lower risk but was statistically significant (HR 0.78, 95% CI 0.54, 1.12). These benefits remained after excluding patients with concomitant asthma.CONCLUSIONS: The results suggest that treatment of COPD patients with ICS, alone or in combination with SAL, may significantly decrease risk of an initial COPD hospitalization over 12 months compared to IPR. This effect was independent of concomitant asthma diagnosis. The combination of ICS + SAL, was associated with the greatest decrease in risk.
The initial use of ICS and ICS + SAL in patients with COPD my control severe exacerbations compared to IPR.
R.H. Stanford, Employee of GlaxoSmithKline, Industry.