BMJ

COPD triple therapy: Are dry powder inhalers as effective as metered dose inhalers?

December 31, 2024

Use of a triple metered dose inhaler (budesonide-glycopyrrolate-formoterol) wasn’t associated with improved clinical outcomes compared with a triple dry power inhaler (fluticasone-umeclidinium-vilanterol) in COPD patients, according to this cohort study of U.S. claims data. Dry powder inhalers may not be suitable for all patients; however, fluticasone-umeclidinium-vilanterol represents a safe and effective alternative to budesonide-glycopyrrolate-formoterol that avoids the 20-fold higher greenhouse gas emissions associated with metered dose inhalers.

Study details: In this 1:1 propensity-score matched cohort study, longitudinal commercial U.S. claims data identified 20,388 new initiators of budesonide-glycopyrrolate-formoterol or fluticasone-umeclidinium-vilanterol between January 1, 2021, and September 30, 2023, with a diagnosis of COPD and aged 40 years or older. The main outcome measures were first moderate or severe COPD exacerbation (effectiveness) and first admission to hospital with pneumonia (safety) while on treatment. Potential confounders were measured in the 365 days before cohort entry and included in propensity scores.

Results: Patients who received budesonide-glycopyrrolate-formoterol had a 9% higher incidence of first moderate or severe COPD exacerbation (hazard ratio 1.09 (95% CI, 1.04 - 1.14); number needed to harm, 38) compared with patients receiving fluticasone-umeclidinium-vilanterol and an identical incidence of first admission to hospital with pneumonia. The hazard of first moderate COPD exacerbation was 7% higher (1.07 (CI, 1.02 - 1.12); number needed to harm, 54) and the hazard of first severe COPD exacerbation 29% higher (1.29 (CI, 1.12 - 1.48); number needed to harm, 97) among those receiving budesonide-glycopyrrolate-formoterol compared with fluticasone-umeclidinium-vilanterol.

Source:

Feldman WB, et al. (2024, December 30). BMJ. Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study. https://www.bmj.com/content/387/bmj-2024-080409