PURPOSE: To compare the risk of hospitalizations and/or emergency department (ED) visits among Medicaid COPD patients prescribed various medications. This study analyzed both COPD-related events and all-cause events.
METHODS: Observational, retrospective study in Texas Medicaid. Eligible patients were aged 40 to 65 years, with a primary or secondary diagnosis of COPD, and with ≥1 prescription for ipratropium (IPR), inhaled corticosteroids (ICS), salmeterol (SAL) or fluticasone proprionate/salmeterol (FSC) between September 1, 2000, and December 31, 2003. Outcome of interest was time to first ED/hospitalizations 12 months post index medication date. A matched propensity sample was used as a sensitivity analysis.
RESULTS: 9,671 patients were included: IPR (5,786), ICS (1,561), SAL (600), and FSC (1,724). After adjusting for baseline characteristics (prior ED/hospitalizations, oral corticosteroid, albuterol, theophylline use, comorbidities, asthma diagnosis, age, race, and gender), compared with IPR, all cohorts were associated with significantly lower risk of a COPD-related ED/hosp event; ICS (HR 0.822 95% CI, 0.694–0.974), SAL (HR, 0.721 95% CI, 0.551–0.944), FSC (HR, 0.720 95% CI, 0.605–0.857). When comparing all-cause events, only FSC had a significantly lower risk than IPR (FSC, [HR 0.894 95% CI, 0.842–0.949]). Propensity matched sample of FSC versus IPR (1:1), showed that FSC had a lower risk for both COPD-related (HR, 0.760 [95% CI, 0.617–0.936]) and all-cause (HR, 0.909 [95% CI, 0.845–0.978]) ED/hosp events.
CONCLUSION: FSC was associated with a significantly lower risk of COPD-related and all-cause ED/hosp events compared with IPR during 12 months of therapy in a Medicaid population. Additional studies are needed to confirm these finding across different populations.
CLINICAL IMPLICATIONS: This study provides additional evidence of the clinical benefit (reduced COPD exacerbations) of a fixed dosed ICS/LABA compared to inhaled anti-cholinergic treatment in COPD patients.
DISCLOSURE: Karen Rascati, Grant monies (from industry related sources) K. Rascati has received research grants from GSK; Employee M. Akazawa is currently completing a fellowhip at GSK. R. Stanford is an employee of GSK; Consultant fee, speaker bureau, advisory committee, etc. K. Rascati has served as a consultant to GSK.