Using a LABA in combination with a LAMA rather than an inhaled corticosteroid to treat COPD is more effective in preventing exacerbations, claim researchers.
Patients receiving a combination of indacterol-glycopyrronium experienced 11% fewer exacerbations over the year than patients taking salmeterol-fluticasone.
The indacterol-glycopyrronium group also experienced a significantly longer time to their first COPD exacerbation – 71 days versus 51 – and a 17% reduction in the rate of moderate or severe exacerbations.
Pneumonia incidence was also significantly lower in the group LABA-LAMA group – at 3.2% compared to 4.8% in patients taking salmeterol-fluticasone.
The team conducted a double-blind randomised trial comparing indacterol-glycopyrronium – a LABA-LAMA combination – with a LAMA and inhaled corticosteroid combination in salmeterol-fluticasone to assess the effect of each combination on the number of COPD exacerbations over the course of a year.
Current NICE guidelines recommend GPs offer a LABA with either an inhaled corticosteroid or a LAMA to patients who are breathless or suffer exacerbations despite using a SABA, and who have an FEV1 <50%.
But the role of inhaled corticosteroids in COPD has been questioned, with research linking the drugs to an increased risk of pneumonia.
The study, published in the New England Journal of Medicine, involved over 3,000 patients with COPD who had experienced at least one exacerbation within the past year and compared treating patients with a once-daily dose of indacterol-glycopyrronium with a twice-daily dose of salmeterol-fluticasone.
Concluding in the paper, the team write: ‘We found that among patients with COPD who had a history of exacerbation during the previous year, indacterol-glycopyrronium was consistently more effective than salmeterol-fluticasone in preventing exacerbations and was associated with no detectable increase in adverse events.’
Lead author Professor Wisia Wedzicha, professor of respiratory medicine at the National Heart and Lung Institute, said: ‘These findings confirm our need to reassess the widespread use of inhaled corticosteroids and consider steroid-free treatment alternatives for both our exacerbating and non-exacerbating patients.’