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A recent study published in The BMJ on December 30, 2024, has provided new insights into the effectiveness and safety of two popular single-inhaler triple therapies for the treatment of chronic obstructive pulmonary disease (COPD). The study found that budesonide-glycopyrrolate-formoterol, a twice-daily metered dose inhaler, does not show improved clinical outcomes compared to fluticasone-umeclidinium-vilanterol, a once-daily dry powder inhaler.
Led by Dr. William B. Feldman of Brigham and Women’s Hospital in Boston, the study compared the two therapies in a new-user, 1:1 propensity score-matched cohort involving 20,388 patients. The researchers focused on real-world outcomes in routine clinical practice and assessed the incidence of moderate to severe COPD exacerbations, hospitalizations due to pneumonia, and other clinical measures.
The results revealed that patients who used budesonide-glycopyrrolate-formoterol had a higher risk of experiencing a first moderate or severe COPD exacerbation. Specifically, the incidence of a first moderate or severe exacerbation was significantly higher in the budesonide-glycopyrrolate-formoterol group, with a hazard ratio of 1.09 (95% CI, 1.04 to 1.14) compared to those who used fluticasone-umeclidinium-vilanterol. The number needed to harm for this outcome was 38. Furthermore, the risk of a first severe exacerbation was notably higher with budesonide-glycopyrrolate-formoterol (hazard ratio 1.29; 95% CI, 1.12 to 1.48), with a number needed to harm of 97.
Despite these findings, the study found no difference between the two groups in the incidence of hospitalization due to pneumonia (hazard ratio 1.00; 95% CI, 0.19 to 1.10). The study’s findings remained consistent across prespecified sensitivity analyses, reinforcing the robustness of the data.
Dr. Feldman and colleagues also noted the environmental benefits of the dry powder inhaler, which has a lower carbon footprint than the metered dose inhaler. They suggested that the results may provide reassurance to healthcare systems aiming to reduce greenhouse gas emissions without compromising patient outcomes.
“Our study may provide reassurance to health systems seeking to decrease greenhouse gas emissions by reducing the use of metered dose inhalers,” said Dr. Feldman. “The single-inhaler triple therapy with the lower carbon footprint, fluticasone-umeclidinium-vilanterol, was also associated with slightly improved clinical outcomes.”
The study’s authors disclosed financial ties to the pharmaceutical and health information technology industries.
For further details, the full study can be accessed in the British Medical Journal (BMJ), with the citation: William B. Feldman et al, Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study, BMJ (2024). DOI: 10.1136/bmj-2024-080409.
