Dual bronchodilation vs triple therapy in the "real-life" COPD DACCORD study

  • Background: No observational studies have evaluated the "real-world" effectiveness of dual bronchodilation comprising a long-acting β2-agonist plus a long-acting muscarinic antagonist vs that of triple therapy (long-acting β2-agonist plus long-acting muscarinic antagonist plus inhaled corticosteroid) in COPD. Materials and methods: DACCORD is a non-interventional, observational clinical study that recruited patients following COPD maintenance therapy initiation or change in maintenance therapy between or within therapeutic class. Given the non-interventional nature of the study, the decision to initiate or change medication had to be made by the patients’ physicians prior to inclusion in DACCORD. We used a matched-pairs analysis to compare disease progression in two patient groups: those receiving dual bronchodilation vs those receiving triple therapy (each group n=1,046). Results: In two subgroups of patients matched according to a broad range of demographic and disease characteristics, over 1 year, fewer patients receiving dual bronchodilation exacerbated than those receiving triple therapy (15.5% vs 26.6%; P<0.001), with a greater improvement from baseline in COPD Assessment Test total score at 1 year (mean±SD -2.9±5.8 vs -1.4±5.5; P<0.001). When analyzed according to prior therapy, the highest rate of exacerbations was in patients on triple therapy prior to the study who remained on triple therapy. Those changing from mono-bronchodilator to dual bronchodilation had the greatest COPD Assessment Test total score improvement. Conclusion: In this "real-life" cohort of patients with COPD, most of whom had not exacerbated in the 6 months prior to entry, triple therapy did not seem to improve outcomes compared with dual bronchodilation in terms of either exacerbations or health status. Our analyses clearly demonstrate the potential impact of prior medication on study results, something that should be taken into account when interpreting the results even of controlled clinical trials.
Author:Roland Buhl, Carl-Peter Criée, Peter Kardos, Claus F. Vogelmeier, Konstantinos Kostikas, Nadine S. Lossi, Heinrich Worth
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/30197512
Parent Title (English):The International journal of chronic obstructive pulmonary disease
Publisher:DOVE Medical Press
Place of publication:Albany, Auckland
Contributor(s):Richard Russell
Document Type:Article
Year of Completion:2018
Date of first Publication:2018/08/24
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2018/09/20
Tag:COPD; COPD course and therapy; acute exacerbations of COPD; bronchodilator; health-related quality of life
Page Number:12
First Page:2557
Last Page:2568
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Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell 3.0