Impact of Salmeterol/Fluticasone Propionate versus Salmeterol on Exacerbations in Severe Chronic Obstructive Pulmonary Disease

Kardos, Péter; Wencker, Marion; Glaab, Thomas; Vogelmeier, Claus

doi:10.1164/rccm.200602-244oc

Cited by 293 publications

(210 citation statements)

References 41 publications

Supporting

Mentioning

182

Contrasting

Unclassified

Order By: Relevance

“…The risk was higher in patients with more severe COPD, in particular in patients with GOLD stage 4 and in patients with Medical Research Council (MRC) dyspnoea scores of 4e5 [33,34]. In the INSPIRE study, a similarly increased risk of exacerbations treated with antibiotics was observed in patients treated with a fluticasone/salmeterol combination compared to patients treated with tiotropium (7.6% vs 3.6%, respectively, p < 0.008) [35]; moreover, a one-year study comparingfluticasone/ salmeterol combination with fluticasone alone also showed similar results (4.5% vs 1.4% in FS and F respectively, p < 0.05) [36]. A more detailed analysis of the TORCH and INSPIRE studies revealed an excess risk of 3.6 pneumonia events per 100 patients and of 5.7 events per 100 patients, respectively, corresponding to a number needed to treat (NNT) of 28 and 18 patients, in patients treated with fluticasone.…”

Section: Potential Side Effects Of Ics In Copd: the Risk Of Pneumoniamentioning

confidence: 70%

Differences in the efficacy and safety among inhaled corticosteroids (ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD): Role of ICS

Latorre

Novelli

Vagaggini

et al. 2015

Pulmonary Pharmacology & Therapeutics

View full text Add to dashboard Cite

a b s t r a c tInhaled corticosteroids (ICS) are frequently recommended for the treatment of asthma and COPD, often in combination with long-acting beta2-agonists (LABA), depending on the severity of the disease and/or on the specific phenotype. Several ICS/LABA combinations are currently available that differ in their pharmacokinetic characteristics and dose of both components. Thus, this review assesses differences in the efficacy and the safety profiles of the ICS components in the two more frequently used ICS/LABA combinations (budesonide/formoterol and fluticasone/salmeterol) for the management of COPD.Whereas the basic mechanism of action is similar for all ICS (binding with the intracellular glucocorticoid receptor, which mediates both genomic and non genomic effects), the pharmacokinetic and characteristics of ICS are quite different in terms of receptor affinity, bioavailability, lipophilicity and drug persistence in the airways. Fluticasone persists longer in airway mucus and requires more time to dissolve in the lining fluid and then enter the airway wall, whereas budesonide is cleared more quickly from the airways.Comparative efficacy of the two major ICS/LABA combinations recommended for the treatment of COPD show similar efficacy in terms of reduction of exacerbations, improvement in forced expiratory volume in the first second (FEV1) and quality of life. One retrospective cohort study suggested a greater efficacy for the budesonide/formoterol combination on hospital or emergency department admissions, oral corticosteroid courses, and addition of tiotropium, and an observational real-life study reported a greater reduction of COPD exacerbations with budesonide/formoterol than with fluticasom/salmeterol combination.Among the potential side effects of chronic ICS treatment in patients with COPD, recently the use of fluticasone or fluticasone/salmeterol combination has been associated with a higher prevalence of pneumonia in the major long-term studies. On the other hand, no similar increased risk of pneumonia has been reported in patients with COPD treated with the budesonide/formoterol combination. A recent population-based cohort study from the Quebec database showed that the adjusted odds ratio for having severe pneumonia was higher for fluticasone (2.1) than for budesonide (1.17) or other ICS (1.41). Of the ICS studied, only fluticasone demonstrated a dose-related increase in risk of pneumonia in patients with COPD. This difference between fluticasone and budesonide may be explained by the longer retention of fluticasone in the airways, with potentially greater inhibition of type-1 innate immunity.Therefore, the risk:benefit ratio should be evaluated thoroughly when choosing an ICS/LABA combination for patients with COPD.

show abstract

Section: Potential Side Effects Of Ics In Copd: the Risk Of Pneumoniamentioning

confidence: 70%

Differences in the efficacy and safety among inhaled corticosteroids (ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD): Role of ICS

Latorre

Novelli

Vagaggini

et al. 2015

Pulmonary Pharmacology & Therapeutics

View full text Add to dashboard Cite

show abstract

“…Some of these medications may increase the likelihood of infections: atypical antipsychotics may impair consciousness and increase the frequency of aspiration (Knol W & Al, 2008;Gau JT & Al, 2010); H2 blockers and protonic pump inhibitors (PPI) lead to decreased gastric acidity and may contribute to increased gastrointestinal infections (Laheij RI & Al;2004;Gulmez SE & Al, 2007;Eom CS & Al 2011;Laria A & Al, 2011). Oral and inhaled glucocorticoid therapy are associated with an increased dose-dependent risk of infections (Ernst P & Al, 2007;Calverley PM & Al, 2007;Kardos P & Al, 2007;Drummond MB & Al, 2008;Singh S & Al, 2009;Smitten AL, & Al 2008;Dixon WG & Al, 2011).…”

Section: Drugs Use In Elderly Nursing Homes Residentsmentioning

confidence: 99%

Antibiotic Resistance in Nursing Homes

Ricci¹,

Barrionuevo²,

Cosso³

et al. 2012

Antibiotic Resistant Bacteria - A Continuous Challenge in the New Millennium

View full text Add to dashboard Cite

“…The MID for the SGRQ is well established 28 and studies do report differences in the proportion of patients achieving this. For example, a study of the effects of salmeterol/fluticasone versus salmeterol showed that the number of patients with a reduction in SGRQ of 4 points or more was significantly higher in the combination group (41.7% v 30%), 29 and in the UPLIFT study a higher proportion of patients in the tiotropium group than in the placebo group had an improvement of 4 units or more in the SGRQ total scores from baseline at 4 years (45% vs. 36%).…”

Section: How Are the Data Presented?mentioning

confidence: 99%

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Halpin

2010

Primary Care Respiratory Journal

View full text Add to dashboard Cite

SummaryTranslating the growing evidence base on COPD management into practice can be challenging and understanding the strengths and weakness of published studies is crucial. Studies should conform to the standards of CONSORT statement; they should be sufficiently powered, participants should be randomised, there should be assignment concealment, and the outcome measures and analyses should be decided in advance.The interpretation of the results may be affected by age and severity inclusion criteria for the study and the exclusion of patients with co-morbid illnesses. Whether previous medication is continued or stopped can affect the interpretation of the results. Secondary analyses in sub-groups should be viewed with caution unless pre-specified and accommodated in the trial design and power calculations. Real world observational studies may be confounded by non-randomisation of participants but can sometimes yield valuable insights.The way in which the results are presented can influence their interpretation and their magnitude with respect to minimal important differences as well as statistical significance is important.Research studies help formulate management algorithms but often the questions they address are too specific to allow evidence-based sequencing of therapies.

show abstract

Impact of Salmeterol/Fluticasone Propionate versus Salmeterol on Exacerbations in Severe Chronic Obstructive Pulmonary Disease

Abstract: This study demonstrates that combination therapy with salmeterol/fluticasone compared with salmeterol monotherapy significantly reduces the frequency of moderate/severe exacerbations in patients with severe COPD.

Cited by 293 publications

References 41 publications

Differences in the efficacy and safety among inhaled corticosteroids (ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD): Role of ICS

Differences in the efficacy and safety among inhaled corticosteroids (ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD): Role of ICS

Antibiotic Resistance in Nursing Homes

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Contact Info

Product

Resources

About