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Comparative Study
. 2018 Sep 28;28(1):36.
doi: 10.1038/s41533-018-0102-x.

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

Miriam Barrecheguren  1 , Mónica Monteagudo  2   3 , Marc Miravitlles  4
Affiliations
Comparative Study

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

Miriam Barrecheguren et al. NPJ Prim Care Respir Med. .

Abstract

This epidemiological study aimed to describe and compare the characteristics and outcomes of COPD patients starting treatment with a long-acting anti-muscarinic (LAMA) or a combination of a long-acting beta-2 agonist (LABA)/LAMA in primary care in Catalonia (Spain) over a one-year period. Data were obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database containing information of 5.8 million inhabitants (80% of the population of Catalonia). Patients initiating treatment with a LAMA or LABA/LAMA in 2015 were identified, and information about demographic and clinical characteristics was collected. Then, patients were matched 1:1 for age, sex, FEV1%, history of exacerbations, history of asthma and duration of treatment, and the outcomes between the two groups were compared. During 2015, 5729 individuals with COPD started treatment with a LAMA (69.8%) or LAMA/LABA (30.2%). There were no remarkable differences between groups except for a lower FEV1 and more previous hospital admissions in individuals on LABA/LAMA. The number of tests and referrals was low and decreased in both groups during follow-up. For the same severity status, the evolution was similar with a reduction in exacerbations in both groups. Treatment was changed during follow-up in up to 34.2% of patients in the LABA/LAMA and 26.3% in the LAMA group, but adherence was equally good for both. Our results suggest that initial therapy with LAMA in monotherapy may be adequate in a significant group of mild to moderate patients with COPD and a low risk of exacerbations managed in primary care.

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Conflict of interest statement

M.B. has received speaker fees from Grifols, Menarini, GSK and consulting fees from Novartis and Gebro Pharma. M.M. has received speaker fees from Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Grifols and Novartis, and consulting fees from Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Gebro Pharma, CSL Behring, Novartis and Grifols. The other author declares no competing interests.

Figures

Fig. 1
Fig. 1
Changes in the treatment pattern at 12 months of follow-up compared to baseline. Continous arrow: step-up or equivalent treatment; dashed arrow: step-down treatment. LABA long-acting beta-2 agonist, LAMA long-acting anti-muscarinic, ICS inhaled corticosteroid
Fig. 2
Fig. 2
Flowchart of the patients included in the study. SIDIAP information system for research in primary care, COPD chronic obstructive pulmonary disease, LABA long-acting beta-2 agonist, LAMA long-acting anti-muscarinic, Hx history, FEV1 forced expiratory volume in 1 s, FVC forced vital capacity
See this image and copyright information in PMC

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