Less COPD Exacerbation Risks for Tiotropium Plus Olodaterol

Jennifer Quint, MBBS, BSc, MSc, PhD

Recent study findings demonstrate treatment with tiotropium plus olodaterol results in a lower risk escalation of factors related to chronic obstructive pulmonary disease (COPD) versus long-acting β2-agonist (LABA) plus inhaled corticosteroid in patients with the condition.

Guidelines recommend COPD maintenance treatment with a combined LAMA plus LABA therapy. Inhaled corticosteroid treatment can be added if a patient has high levels eosinophils. But COPD patients are typically prescribed LABA plus inhaled corticosteroid therapy despite such use leading to an increased risk of pneumonia.

Investigators found there was a lower risk escalation of triple therapy, COPD exacerbations, pneumonia, and adverse outcomes in patients treated with tiotropium plus olodaterol.

Jennifer Quint, MBBS, BSc, MSc, PhD, and colleagues analyzed administrative healthcare claims and laboratory results data from the HealthCore Integrated Research Database for COPD patients initiating first treatment with tiotropium/olodaterol versus LABA/inhaled corticosteroid. The team followed patients until the discontinuation or switch of their index treatment, until the end of health plan enrollment, or 1 year after the index date.

Patients at least 40 years old with a diagnosis of COPD but not asthma were included. Those in the study had at least 1 year of medical or pharmacy health plan eligibility prior to the index date to allow identification of new users of tiotropium/olodaterol and LABA/inhaled corticosteroid, and measurement of baseline covariates.

Quint and the investigators used a Cox proportional hazard regression model to assess risk of escalation to triple therapy, COPD exacerbation, pneumonia, or an adverse outcome. Subgroup data were analyzed based on circulating eosinophil levels and exacerbation history.

Overall, 42,953 patients were included in the study population (2600 tiotropium/olodaterol; 40,353 LABA/inhaled corticosteroid. Of the patients, those taking LABA or inhaled corticosteroid were nearly three-fold as likely to have risk of escalation to triple therapy compared to tiotropium/olodaterol patients (HR, 2.9; 95% CI, 2.84-2.97 vs .54 95% CI, .46-.64).

COPD exacerbations were also more likely among LABA/inhaled corticosteroid patients (HR, 2.43; 95% CI, 2.37-2.49) compared to those taking tiotropium/olodaterol (HR, 1.63; 95% CI, 1.47-1.81). Further, pneumonia requiring hospitalization was slightly more likely to occur in LABA/inhaled corticosteroid patients compared to patients on tiotropium/olodaterol (HR, .34; 95% CI, .32-.37 vs HR, .23; 95% CI, .18-.3).

When measuring the risk of an adverse outcome, patients in the LABA/inhaled corticosteroid group were three-times as likely to have baseline eosinophils <300 cells/μL than those in the tiotropium/olodaterol group (HR, 6.38; 95% CI, 6.02-6.77 vs HR, 2.09; 95% CI, 1.55-2.82). For infrequent exacerbation history, the tiotropium/olodaterol group had a hazard ratio of 1.71 (95% CI, 1.53-1.91) compared to HR, 4.31 (95% CI, 4.21-4.4) in the LABA/inhaled corticosteroid group. Frequent exacerbation history was more common in the LABA/inhaled corticosteroid group (HR, 10.63; 95% CI, 10.36-10.9 vs 3.95; 95% CI, 3.4-4.6).

The study, “COPD maintenance therapy with tiotropium/olodaterol versus LABA/ICS: an assessment of the risk of treatment escalation and adverse outcomes in over 40,000 patients,” was presented as part of the 2020 American Thoracic Society International Conference.