Budesonide/formeterol treatment in COPD patients is linked with a lower risk of pneumonia, compared with fluticasone/salmeterol shows a large observational study.
Swedish researchers reviewed medical records for 5,468 patients with COPD being treated with two different fixed combinations of inhaled corticosteroids and long acting beta-2 agonists. They were studied for yearly pneumonia events, admission to hospital related to pneumonia, and mortality over a 10-year period.
Some 2,115 (39%) suffered at least one recorded episode of pneumonia during the study period. Admissions to hospital because of pneumonia were 74% higher in the fluticasone/salmeterol group (7.4 per 100 patient years), compared with the budesonide/formeterol group (4.3 per 100 patient years). The pneumonia rate was 73% higher in those taking fluticasone/salmeterol, compared with budesonide/formeterol. Some 149 patients (52 patients in the budesonide/formeterol group and 97 in the fluticasone/salmeterol group) died with pneumonia listed as a cause of death, corresponding to a 76% increase in risk of mortality related to pneumonia with fluticasone/salmeterol versus budesonide/formeterol.
What this means for GPs
The researchers noted that the increased risk of pneumonia in patients treated with fluticasone/salmeterol ‘might be related to differences in immunosuppressant potency and pharmacokinetic and pharmacodynamic properties between budesonide and fluticasone’. They warn that the magnitude of the intraclass difference in pneumonia ‘needs to be put in context with the benefits of each regimen in preventing exacerbation’ and that long term randomised controlled trials are warranted.
A GSK spokesperson said: ‘Seretide has a strong, publicly available portfolio of evidence demonstrating its positive benefit/risk profile. We believe Seretide is, and will continue to be, an important and valuable medicine in the global treatment of asthma and COPD.’