Study finds no clinical advantage of budesonide inhaler over fluticasone in COPD
In a recent study published in BMJ, researchers from the United States and Canada investigated the comparative effectiveness and safety of two single-inhaler triple therapies for chronic obstructive pulmonary disease (COPD). The study focused on budesonide-glycopyrrolate-formoterol and fluticasone-umeclidinium-vilanterol in preventing COPD exacerbations and pneumonia hospitalizations in real-world settings.
Background
COPD is a progressive respiratory condition characterized by airflow limitations and exacerbations that worsen patients' quality of life and increase healthcare burden. Triple inhaler therapy, combining an inhaled corticosteroid with a long-acting beta-agonist and a long-acting muscarinic antagonist, has been recommended for certain patients to manage symptoms and prevent exacerbations.
About the Study
The study compared the effectiveness and safety of budesonide-glycopyrrolate-formoterol (administered twice daily through metered-dose inhalers) and fluticasone-umeclidinium-vilanterol (administered once daily using a dry powder inhaler) using real-world data from US health claims from 2021 to 2023. Participants were aged 40 years and older with a valid COPD diagnosis and were new users of either therapy.
Major Findings
The study found that fluticasone-umeclidinium-vilanterol resulted in fewer COPD exacerbations compared to budesonide-glycopyrrolate-formoterol. Among 20,388 matched pairs, the hazard of a moderate or severe exacerbation was 9% higher for budesonide-glycopyrrolate-formoterol users. However, the rate of hospitalization for pneumonia was identical between the two therapies.
Conclusions
The study concluded that fluticasone-umeclidinium-vilanterol triple inhaler therapy demonstrated a slight clinical advantage in preventing COPD exacerbations without increasing the risk of adverse events such as pneumonia. These findings support the use of dry powder inhalers as effective alternatives to metered-dose inhalers, aligning with efforts to reduce greenhouse gas emissions while maintaining patient care standards.
Journal reference:
- Feldman, W. B., Suissa, S., Kesselheim, A. S., Avorn, J., Russo, M., Schneeweiss, S., & Wang, S. V. (2024). Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study. BMJ, 387.
doi:10.1136/bmj-2024-080409, https://www.bmj.com/content/387/bmj-2024-080409