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dc.contributorVall d'Hebron Barcelona Hospital Campus
dc.contributor.authorMiravitlles Fernández, Marc
dc.contributor.authorVerhamme, Katia
dc.contributor.authorCalverley, Peter
dc.contributor.authorDreher, Michael
dc.contributor.authorBayer, Valentina
dc.contributor.authorGardev, Asparuh
dc.date.accessioned2022-08-10T09:32:17Z
dc.date.available2022-08-10T09:32:17Z
dc.date.issued2022-03-11
dc.identifier.citationMiravitlles M, Verhamme K, Calverley PMA, Dreher M, Bayer V, Gardev A, et al. A Pooled Analysis of Mortality in Patients with COPD Receiving Dual Bronchodilation with and without Additional Inhaled Corticosteroid. Int J Chron Obstruct Pulmon Dis. 2022 Mar 11;17:545–58.
dc.identifier.issn1178-2005
dc.identifier.urihttp://hdl.handle.net/11351/7978
dc.descriptionCOPD; Inhaled corticosteroid; Mortality
dc.description.abstractBackground: Recent studies report a lower mortality rate during treatment with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) versus LAMA/LABA in patients with symptomatic chronic obstructive pulmonary disease (COPD) and a history of exacerbations. Objective: We compared time to all-cause mortality with LAMA/LABA versus LAMA/LABA/ICS in patients with mild-to-very-severe COPD and a predominantly low exacerbation risk. Methods: Data were pooled from six randomized controlled trials (TONADO 1/2, DYNAGITO, WISDOM, UPLIFT and TIOSPIR; LAMA/LABA: n = 3156, LAMA/LABA/ICS: n = 11,891). Analysis was on-treatment and data were censored at 52 weeks. Patients on LAMA/LABA/ICS received ICS prior to study entry, which was not withdrawn at randomization. Patients on LAMA/LABA/ICS were propensity score (PS)-matched to patients on LAMA/LABA who had not previously received ICS; covariates included age, sex, geographical region, smoking status, post-bronchodilator forced expiratory volume in 1 second percent predicted, exacerbation history in previous year, body mass index and time since diagnosis. Time to all-cause mortality was assessed using Cox proportional hazard regression models. Results: After PS matching, 3133 patients on LAMA/LABA and 3133 patients on LAMA/LABA/ICS were analyzed. Fewer than 20% of patients reported ≥ 2 exacerbations in the prior year (LAMA/LABA: 19.1%; LAMA/LABA/ICS: 19.0%). There were 41 (1.3%) deaths on LAMA/LABA and 45 (1.4%) deaths on LAMA/LABA/ICS. No statistically significant difference in time to death was observed between treatment arms (hazard ratio for LAMA/LABA 1.06; 95% confidence intervals 0.68, 1.64; P = 0.806). Sensitivity analyses conducted using different covariates or in an intent-to-treat population showed similar results. Conclusion: This pooled analysis of over 6000 patients with mild-to-very-severe COPD and predominantly low exacerbation risk showed no differences in mortality with LAMA/LABA versus LAMA/LABA/ICS, suggesting that the survival benefit of triple therapy seen in some recent studies may be specific to a high-risk population. This supports current Global Initiative for Chronic Obstructive Lung Disease recommendations that triple therapy should be reserved for the subpopulations of patients who need it the most (eg, those with an eosinophilic phenotype and a high risk of exacerbations) to avoid ICS overuse.
dc.language.isoeng
dc.publisherDove Medical Press
dc.relation.ispartofseriesInternational Journal of Chronic Obstructive Pulmonary Disease;17
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.sourceScientia
dc.subjectPulmons - Malalties obstructives - Mortalitat
dc.subjectCorticosteroides - Ús terapèutic
dc.subjectBroncodilatadors
dc.subject.meshPulmonary Disease, Chronic Obstructive
dc.subject.mesh/mortality
dc.subject.meshBronchodilator Agents
dc.subject.meshAdrenal Cortex Hormones
dc.titleA Pooled Analysis of Mortality in Patients with COPD Receiving Dual Bronchodilation with and without Additional Inhaled Corticosteroid
dc.typeinfo:eu-repo/semantics/article
dc.identifier.doi10.2147/COPD.S350167
dc.subject.decsenfermedad pulmonar obstructiva crónica
dc.subject.decs/mortalidad
dc.subject.decsbroncodilatadores
dc.subject.decshormonas de la corteza suprarrenal
dc.relation.publishversionhttps://doi.org/10.2147/COPD.S350167
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dc.audienceProfessionals
dc.contributor.organismesInstitut Català de la Salut
dc.contributor.authoraffiliation[Miravitlles M] Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. [Verhamme K] Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands. [Calverley PMA] Clinical Science Centre, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. [Dreher M] Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany. [Bayer V] Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA. [Gardev A] Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
dc.identifier.pmid35309285
dc.identifier.wos000772887200002
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess


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