Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD)

Ni, Han; Htet, Aung; Moe, Soe

doi:10.1002/14651858.cd011897.pub2

Cited by 7 publications

(2 citation statements)

References 83 publications

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“…16 Although the findings from randomised controlled trials (RCTs) appear to be reassuring about the cardiovascular safety of long-acting bronchodilators, the trials were usually underpowered for safety endpoints, and patients with pre-existing cardiovascular disease and other comorbidities were frequently excluded. 17 Metaanalyses of those RCTs have also had limited power to examine cardiovascular risk [9][10][11][12][13][14][15] and the authors of one review 9 reported they were unable to undertake a metaanalysis of serious cardiovascular events because of a lack of consistency in reporting those outcomes. These limitations have prompted calls for more inclusive RCTs, as well as large observational studies, in real-world settings of clinical care.…”

Section: Key Messagesmentioning

confidence: 99%

Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

Parkin

Williams

Barson³

et al. 2021

BMJ Open Resp Res

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BackgroundCardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case–control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.MethodsWe used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.ResultsFrom the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).ConclusionIn real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.

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Section: Key Messagesmentioning

confidence: 99%

Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

Parkin

Williams

Barson³

et al. 2021

BMJ Open Resp Res

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“…There is also concern that long‐acting bronchodilators (long‐acting muscarinic antagonists [LAMAs] and long‐acting beta2‐agonists [LABAs]) might increase the risk of acute coronary events still further [ 7 ]. This is important because coronary events are responsible for more deaths than respiratory failure in patients with COPD [ 8 ] and meta‐analyses of randomised controlled trials (RCTs) have found that the use of long‐acting bronchodilators (as mono‐therapy [ 9 , 10 , 11 , 12 ] or dual therapy [ 13 , 14 , 15 ]) is associated with relatively small patient‐relevant benefits. Moreover, successive updates of the Global Initiative for Chronic Obstructive Lung Disease guidelines [ 16 ] and a recent American Thoracic Society clinical practice guideline [ 17 ] have recommended the combined use of a LAMA and LABA in patients whose symptoms are not well controlled.…”

Section: Introductionmentioning

confidence: 99%

Dual versus single long‐acting bronchodilator use could raise acute coronary syndrome risk by over 50%: A population‐based nested case–control study

et al. 2021

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Background Coronary heart disease occurs more frequently among patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. While some research suggests that long‐acting bronchodilators might confer an additional risk of acute coronary syndrome (ACS), information from real‐world clinical practice about the cardiovascular impact of using two versus one long‐acting bronchodilator for COPD is limited. We undertook a population‐based nested case–control study to estimate the risk of ACS in users of both a long‐acting muscarinic antagonist (LAMA) and a long‐acting beta2‐agonist (LABA) relative to users of a LAMA. Methods The study was based on the primary care PREDICT Cardiovascular Disease Cohort and linked data from regional laboratories and the New Zealand Ministry of Health's national data collections. The underlying cohort (n = 29,993) comprised patients aged 45–84 years, who initiated treatment with a LAMA and/or LABA for COPD between 1 February 2006 and 11 October 2016. 1490 ACS cases were matched to 13,550 controls by date of birth, sex, date of cohort entry (first long‐acting bronchodilator dispensing), and COPD severity. Results Relative to current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a significantly higher risk of ACS (adjusted OR = 1.72; [95% CI: 1.28–2.31]). Conclusion Dual long‐acting bronchodilator therapy, rather than LAMA mono‐therapy, could increase the risk of ACS by more than 50%. This has important implications for decisions about the potential benefit/harm ratio of COPD treatment intensification, given the modest benefits of dual therapy.

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Combined aclidinium bromide and long-acting beta2-agonist for chronic obstructive pulmonary disease (COPD)

Moe

Soe

et al. 2018

Cochrane Database of Systematic Reviews

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Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD)

Cited by 7 publications

References 83 publications

Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

Dual versus single long‐acting bronchodilator use could raise acute coronary syndrome risk by over 50%: A population‐based nested case–control study

Combined aclidinium bromide and long-acting beta2-agonist for chronic obstructive pulmonary disease (COPD)

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