To compare risk of all-cause & COPD-related emergency department (ED) visit/hospitalization in patients with COPD receiving initial maintenance therapy.
Retrospective observational analysis was conducted using data from a large managed care database ( > 30 managed care plans). Patients ≥ 40 years with a primary diagnosis of COPD within 1 year prior to initial treatment and at least 18 months of continuous eligibility were identified. Following cohorts were identified: ipratropium (IP), salmeterol (SL), inhaled corticosteroid (ICS), ICS plus SL in the same inhaler (FS), and IPR and albuterol (AL) in the same inhaler (IP/AL). Logistic regression analysis was performed that determined risk of all cause and COPD-related hosp/emergency room (ER) visit. The model adjusted for baseline differences in age, comorbities, COPD sub type, baseline oral corticosteroid, theophylline and albuterol use.
In all, 14,368 patients were identified, 2122 IP, 1099 SL, 3940 ICS, 3819 FS and 3388 IP/AL. Compared with IP, FS reduced the risk of all-cause ER/hosp by 46 % (OR 0.539, CI: 0.467 to 0.622). In addition, ICS and SL reduced the risk by 41 %, (OR 0.594, CI: 0.516 to 0.683) and 36% (OR 0.640, CI: 0.529 to 0.774), respectively. IP/AL cohort was associated with a 12% risk reduction (OR 0.877, CI: 0.770 to 0.999). FS was also associated with a 69% lower risk (OR 0.309, CI: 0.200 to 0.475) of having a COPD related ER/hosp, while ICS and SL had 58%, (OR 0.419, CI: 0.287 to 0.611) and 61% (OR 0.387, CI: 0.216 to 0.694) lower risk, respectively. A 13% risk reduction, which was not statistically significant, was also observed in the IP/AL cohort (OR 0.868, CI: 0.645 to 1.167).
Treatment of COPD with SL or ICS containing medications, especially when ICS and SL are used in combination (FS), may significantly decrease the risk of all-cause and COPD related ED/hosp compared to treatment with IP alone.
These findings provide further evidence of clinical benefits for FSC in patients with COPD.
Rohit Borker, Employee GlaxoSmithKline