Comparative effectiveness and safety of inhaled corticosteroid plus long-acting β₂-agonist fixed-dose combinations vs. long-acting muscarinic antagonist in bronchiectasis.

IF 3 3区医学 Q2 PHARMACOLOGY & PHARMACY Expert Review of Clinical Pharmacology Pub Date : 2024-01-01 Epub Date: 2024-01-29 DOI:10.1080/17512433.2024.2306218

Vincent Yi-Fong Su, Ting-Lin Ding, Yuh-Lih Chang, Yueh-Ching Chou, Hsuen-En Hwang, Chian-Ying Chou, Chia-Chen Hsu

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Abstract

Background: This study aimed to evaluate the effectiveness and safety of fixed-dose combination (FDC) inhaled corticosteroids/long-acting β₂-agonists (ICS/LABA) in bronchiectasis.

Research design and methods: A retrospective cohort study analyzed electronic medical records of bronchiectasis patients initiating ICS/LABA FDC or LAMA between 2007 and 2021. All bronchiectasis diagnoses were made by radiologists using high-resolution computed tomography.

Results: Of the 1,736 patients, 1,281 took ICS/LABA FDC and 455 LAMA. Among the 694 propensity score matched patients, ICS/LABA FDC had comparable outcomes to LAMA, with HRs of 1.22 (95% CI 0.81-1.83) for hospitalized respiratory infection, 1.06 (95% CI 0.84-1.33) for acute exacerbation, and 1.06 (95% CI 0.66-1.02) for all-cause hospitalization. Beclomethasone/formoterol (BEC/FOR) or budesonide/formoterol (BUD/FOR) led to a lower risk of acute exacerbation compared to fluticasone/salmeterol (FLU/SAL) (BEC/FOR HR 0.59, 95% CI 0.43-0.81; BUD/FOR HR 0.68, 95% CI 0.50-0.93). BEC/FOR resulted in lower risks of hospitalized respiratory infection (HR 0.48, 95% 0.26-0.86) and all-cause hospitalization (HR 0.55, 95% 0.37-0.80) compared to FLU/SAL.

Conclusion: Our findings provide important evidence on the effectiveness and safety of ICS/LABA FDC compared with LAMA for bronchiectasis. BEC/FOR and BUD/FOR were associated with better outcomes than FLU/SAL.

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吸入性皮质类固醇加长效β2-受体激动剂固定剂量组合与长效毒蕈碱拮抗剂在支气管扩张症中的有效性和安全性比较。

研究背景本研究旨在评估固定剂量联合（FDC）吸入皮质类固醇/长效β2-受体激动剂（ICS/LABA）治疗支气管扩张症的有效性和安全性：一项回顾性队列研究分析了2007年至2021年间开始使用ICS/LABA FDC或LAMA的支气管扩张症患者的电子病历。所有支气管扩张症的诊断均由放射科医生使用高分辨率计算机断层扫描做出：在1736名患者中，1281人服用了ICS/LABA FDC，455人服用了LAMA。在 694 名倾向评分匹配的患者中，ICS/LABA FDC 的疗效与 LAMA 相当，住院呼吸道感染的 HR 值为 1.22（95% CI 0.81-1.83），急性加重的 HR 值为 1.06（95% CI 0.84-1.33），全因住院的 HR 值为 1.06（95% CI 0.66-1.02）。与氟替卡松/沙美特罗（FLU/SAL）相比，倍氯米松/福莫特罗（BEC/FOR）或布地奈德/福莫特罗（BUD/FOR）导致急性加重的风险较低（BEC/FOR HR 0.59，95% CI 0.43-0.81；BUD/FOR HR 0.68，95% CI 0.50-0.93）。与 FLU/SAL 相比，BEC/FOR 可降低呼吸道感染住院风险（HR 0.48，95% 0.26-0.86）和全因住院风险（HR 0.55，95% 0.37-0.80）：我们的研究结果为ICS/LABA FDC与LAMA相比治疗支气管扩张症的有效性和安全性提供了重要证据。BEC/FOR和BUD/FOR的疗效优于FLU/SAL。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.30

自引率

2.30%

发文量

127

期刊介绍： Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.