Comparative effectiveness of budesonide/formoterol combination and fluticasone/salmeterol combination among chronic obstructive pulmonary disease patients new to controller treatment: a US administrative claims database study

Kern, David M.; Davis, Jill; Williams, Setareh A.; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

doi:10.1186/s12931-015-0210-x

Cited by 27 publications

(28 citation statements)

References 16 publications

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“…A Canadian study19 also found that the risk of exacerbations requiring emergency department visits (adjusted relative risk [RR] =0.75; 95% CI: 0.58–0.97), hospitalizations (adjusted RR =0.61; 95% CI: 0.47–0.81) for COPD and anticholinergic medication use (adjusted RR =0.71; 95% CI: 0.57–0.89) was lower with fixed-dose budesonide/formoterol than with fixed-dose fluticasone/salmeterol during 1 year of analysis. In contrast to our study, the administrative claims database study conducted by Kern et al20 in the US found similar rates of utilization of health care resources and rates of exacerbations (rate ratio =1.02; 95% CI: [0.96–1.09], P =0.56) between patients initiating budesonide/formoterol or fluticasone/salmeterol during the first year of starting therapy. Since, there is no generally agreed definition for an exacerbation of COPD, because exacerbations have a variety of causes and severities, the direct comparison between studies is difficult 21.…”

Section: Discussioncontrasting

confidence: 99%

“…Both budesonide/formoterol and fluticasone/salmeterol demonstrated reduction in the overall rate of exacerbations, although published studies13,20 suggest differences in the exacerbation rates between the two ICS/LABA combinations (budesonide/formoterol and fluticasone/salmeterol). A matched-cohort, register-linkage study13 in Sweden reported that long-term treatment with a fixed combination of budesonide/formoterol was associated with a significant lower health care consumption-defined exacerbations than fluticasone/salmeterol in patients with COPD (difference of 26.6%; P <0.0001).…”

Section: Discussionmentioning

confidence: 95%

“…Economic analysis in Germany has shown that combining budesonide and formoterol in one device is less costly (in terms of medication, visits, referrals, and hospitalization) compared to combining fluticasone/salmeterol in a real clinical setting 23. In contrast, other studies20,25 have reported no significant differences in total COPD-related medical costs after initiation of combination therapy; however, costs for controller medications for the budesonide/formoterol group were slightly lower during the observation period.…”

Section: Discussionmentioning

confidence: 95%

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Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting

Perrone¹,

Sangiorgi²,

Buda³

et al. 2016

COPD

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AimThe objective of this study was to evaluate the different outcomes associated with the use of budesonide/formoterol compared to fluticasone/salmeterol in fixed combinations in patients with COPD in a “real-world” setting. The outcomes included exacerbation rates and health care costs.Patients and methodsAn observational retrospective cohort analysis, based on administrative databases of three local health units, was conducted. Patients with at least one prescription of fixed-dose combination of inhaled corticosteroids and long-acting β2-agonists (budesonide/formoterol or fluticasone/salmeterol), at dosages and formulations approved for COPD in Italy, between January 1, 2009 and December 31, 2011 (inclusion period), were included. Patients were followed until December 2012, death or end of treatment (follow-up period), whichever occurred first. Patients were included if they were aged ≥40 years and had at least 6 months of follow-up. Propensity score matching was performed to check for confounding effects. Number of hospitalizations for COPD and number of oral corticosteroid and antibiotic prescriptions during follow-up were analyzed using Poisson regression models. The cost analysis was conducted from the perspective of the National Health System.ResultsAfter matching, 4,680 patients were analyzed, of which 50% were males with a mean age of 64±13 years. In the Poisson regression models, the incidence rate ratio for budesonide/formoterol as compared to fluticasone/salmeterol was 0.84 (95% confidence interval [CI]: 0.74–0.96, P=0.010) for number of hospitalizations, 0.89 (95% CI: 0.87–0.92, P<0.001) for number of oral corticosteroid prescriptions and 0.88 (95% CI: 0.86–0.89, P<0.001) for number of antibiotic prescriptions. The mean annual expenditure for COPD management was €2,436 for patients treated with budesonide/formoterol and €2,784 for patients treated with fluticasone/salmeterol.ConclusionAmong patients with COPD, treatment with a fixed combination of budesonide/formoterol was associated with fewer exacerbations and a lower, but not significant, cost of illness than the treatment with fluticasone/salmeterol. Real-world analyses are requested to ameliorate interventions to address unmet needs, optimizing treatment pathways to improve COPD-related burden and outcomes.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

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Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting

Perrone¹,

Sangiorgi²,

Buda³

et al. 2016

COPD

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“…The inclusion criteria differed from PATHOS in that patients who were not currently being treated with ICS were also included in the analysis, and in the follow-up period was shorter (1 versus 2 years) [Kern et al 2015].…”

mentioning

confidence: 99%

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

Iannella

Luna

Waterer

2016

Ther Adv Respir Dis

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There is a considerable amount of evidence that supports the possibility of an increased risk of pneumonia associated with prolonged use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD). However, as yet, no statistically significant increase in pneumonia-related 30-day mortality in patients on ICS has been demonstrated. The lack of objective pneumonia definitions and radiological confirmations have been a major source of bias, because of the similarities in clinical presentation between pneumonia and acute exacerbations of COPD. One of the newer fluticasone furoate studies overcomes these limitations and also provides an assessment of a range of doses, suggesting that the therapeutic window is quite narrow and that conventional dosing has probably been too high, although the absolute risk may be different compared to other drugs. Newer studies were not able to rule out budesonide as responsible for pneumonia, as previous evidence suggested, and there is still need for evidence from head-to-head comparisons in order to better assess possible intra-class differences. Although the exact mechanisms by which ICS increase the risk of pneumonia are not fully understood, the immunosuppressive effects of ICS on the respiratory epithelium and the disruption of the lung microbiome are most likely to be implicated. Given that COPD represents such a complex and heterogeneous disease, attempts are being made to identify clinical phenotypes with clear therapeutic implications, in order to optimize the pharmacological treatment of COPD and avoid the indiscriminate use of ICS. If deemed necessary, gradual withdrawal of ICS appears to be well tolerated. Vaccination against pneumococcus and influenza should be emphasized in patients with COPD receiving ICS. Physicians should keep in mind that signs and symptoms of pneumonia in COPD patients may be initially indistinguishable from those of an exacerbation, and that patients with COPD appear to be at increased risk of developing pneumonia as a complication of ICS therapy.

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“…As a result, more recent guidance suggests that combination LABA/ICS should only principally be prescribed in COPD patients with asthma-like symptoms with exacerbations in view of potential adverse effects [12,21]. It can be difficult though to assess differences in outcomes between the different combination formulations and inhaler types [28][29][30][31][32]; consequently, the choice of inhaler device and ease of use do play an appreciable role in the choice of device prescribed with poor inhaler technique known to compromise care [33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

McCabe

Godman

Kurdi

et al. 2019

Expert Review of Respiratory Medicine

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Background: There is an increasing prevalence of asthma and chronic obstructive pulmonary disease (COPD) worldwide, leading to increased inhaler use. However, there are concerns with inhaler compliance resulting in different patented inhalers and longer-acting formulations. As a result, inhalers are now among the highest expenditure items in ambulatory care in Scotland leading to multiple initiatives to keep within budget without compromising care. Method: This study assesses inhaler utilization and expenditure between 2001 and 2017 alongside health authority initiatives. Results: There was an increase by 137% in inhaler utilization between 2001 and 2017, and a twofold increase in expenditure, driven by the increasing use of patented combination inhalers to address concerns. This is very different to the oral markets where expenditure on proton pump inhibitors, statins, and antihypertensives have fallen considerably recently despite increased volumes due to the increasing use of low-cost generics. However, inhaler expenditure has started to fall with an increasing use of lower cost combinations and initiatives to reduce the steroid burden alongside monitoring patient care. Conclusion: Challenges with using and changing inhalers has meant this market has not followed other high-volume drug classes following patent loss. This is starting to change, with the situation monitored to enhance efficient prescribing alongside continued good quality care.

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Comparative effectiveness of budesonide/formoterol combination and fluticasone/salmeterol combination among chronic obstructive pulmonary disease patients new to controller treatment: a US administrative claims database study

Cited by 27 publications

References 16 publications

Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting

Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting

Inhaled corticosteroids and the increased risk of pneumonia: what’s new? A 2015 updated review

Prescribing trends of inhaler treatments for asthma and chronic obstructive pulmonary disease within a resource-constrained environment in the Scottish national health service: findings and implications

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