Combination therapy superior for elderly with COPD

Combination therapy with long-acting beta-agonists plus inhaled corticosteroids is superior to long-acting beta-agonists alone in older patients with COPD, especially those who also have asthma, according to a report published online Sept. 16 in JAMA.

The combination therapy has proved superior in clinical trials, but those studies excluded older patients, patients with comorbidities (especially asthma), and patients taking long-acting anticholinergic medications. To compare the two treatment approaches in a real world setting, researchers performed a retrospective observational study involving 38,266 Ontario residents (aged 66 and older) who were diagnosed as having COPD and who initiated therapy during an 8-year period.

A total of 8,712 of these adults who were new users of combination long-acting beta-agonists plus corticosteroids were propensity matched with 3,160 who were new users of long-acting beta-agonists alone. The mean age of these participants was 77 years, and they had a median of seven comorbid diseases; 28% had comorbid asthma. These study participants were followed for up to 5 years, with a median follow-up of 2.6 years, said Dr. Andrea S. Gershon of the Institute for Clinical Evaluative Sciences, Toronto, and her associates.

The primary study outcome, a composite of all-cause mortality and COPD-related hospitalization, occurred in 64% of patients in the combination-therapy group, which was a “modest but significantly lower” rate than in the single-therapy group (67%). This small but significant difference persisted when mortality and hospitalizations were analyzed separately. Two subgroups of patients showed even greater benefit from the combination therapy: those with concomitant asthma, and those who were not taking long-acting anticholinergics for their COPD, the investigators reported (JAMA 2014 Sept. 16 [doi:10.1001/jama.2014.11432]).

This study was supported by Physicians’ Services Incorporated Foundation; the Canadian Institutes of Health Research Institute of Nutrition, Metabolism, and Diabetes; the University of Toronto; the Institute for Clinical Evaluative Sciences; and the Ontario Ministry of Health and Long-Term Care. Dr. Gershon and her associates reported no relevant financial conflicts.