Comparative Cardiovascular Safety of LABA/LAMA FDC Versus LABA/ICS FDC in Patients with Chronic Obstructive Pulmonary Disease: a Population-based Cohort Study with a Target Trial Emulation Framework

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2023 Sep 29

PMID 37775734

Authors

Chun-Yu Chen

Sheng-Wei Pan

Chia-Chen Hsu

Jason J Liu

Hiraku Kumamaru

Yaa-Hui Dong

Affiliations

Soon will be listed here.

Abstract

Background: Use of combinations of long-acting β agonists/long-acting muscarinic antagonists (LABA/LAMA) in patients with chronic obstructive pulmonary disease (COPD) is increasing. Nevertheless, existing evidence on cardiovascular risk associated with LABA/LAMA versus another dual combination, LABA/inhaled corticosteroids (ICS), was limited and discrepant.

Aim: The present cohort study aimed to examine comparative cardiovascular safety of LABA/LAMA and LABA/ICS with a target trial emulation framework, focusing on dual fixed-dose combination (FDC) therapies.

Methods: We identified patients with COPD who initiated LABA/LAMA FDC or LABA/ICS FDC from a nationwide Taiwanese database during 2017-2020. The outcome of interest was a hospitalized composite cardiovascular events of acute myocardial infarction, unstable angina, heart failure, cardiac dysrhythmia, and ischemic stroke. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for composite and individual cardiovascular events after matching up to five LABA/LAMA FDC initiators to one LABA/ICS FDC initiator using propensity scores (PS).

Results: Among 75,926 PS-matched patients, use of LABA/LAMA FDC did not show a higher cardiovascular risk compared to use of LABA/ICS FDC, with a HR of 0.89 (95% CI, 0.78-1.01) for the composite events, 0.80 (95% CI, 0.61-1.05) for acute myocardial infarction, 1.48 (95% CI, 0.68-3.25) for unstable angina, 1.00 (95% CI, 0.80-1.24) for congestive heart failure, 0.62 (95% CI, 0.37-1.05) for cardiac dysrhythmia, and 0.82 (95% CI, 0.66-1.02) for ischemic stroke. The results did not vary substantially in several pre-specified sensitivity and subgroup analyses.

Conclusion: Our findings provide important reassurance about comparative cardiovascular safety of LABA/LAMA FDC treatment among patients with COPD.

Citing Articles

Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity.

Dimiene I, Hoppenot D, Vajauskas D, Padervinskiene L, Rimkunas A, Zemaitis M J Clin Med. 2024; 13(10).

PMID: 38792478 PMC: 11121926. DOI: 10.3390/jcm13102937.

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