Real-world comparative effectiveness of three single-inhaler dual bronchodilators for the treatment of COPD

Background Single-inhaler dual bronchodilators are now recommended as initial treatment of COPD for patients with multiple exacerbations or with moderate or severe dyspnoea. It is unclear whether there are differences in effectiveness among commonly used dual bronchodilators.

Methods We identified a cohort of COPD patients, aged ≥40 years, treated during 2017–2020, from the UK Clinical Practice Research Datalink, a real-world practice setting. Inhaled corticosteroid-naïve patients initiating vilanterol–umeclidinium (VIL–UME) were compared with those initiating olodaterol–tiotropium (OLO–TIO) or indacaterol–glycopyrronium (IND–GLY) dual bronchodilators primarily on the incidence of moderate and severe COPD exacerbation over 1 year, and corresponding hazard ratios (HRs), after adjustment by propensity score weighting.

Results The cohort included 15 224 initiators of VIL–UME, 5536 initiators of OLO–TIO and 5059 initiators of IND–GLY. The HR of a moderate or severe exacerbation with VIL–UME was 0.91 (95% CI 0.85–0.97) compared with OLO–TIO and 0.96 (95% CI 0.89–1.03) compared with IND–GLY. The risk of severe exacerbation was not different for VIL–UME when compared with OLO–TIO (HR 1.04, 95% CI 0.86–1.26) and IND–GLY (HR 1.05, 95% CI 0.86–1.28). All-cause mortality was lower with VIL–UME compared with IND–GLY (HR 0.82, 95% CI 0.68–0.98), but not compared with OLO–TIO (HR 0.87, 95% CI 0.72–1.04).

Conclusion In a real-world setting of COPD treatment, the three dual bronchodilator combinations were similarly effective on the risk of a severe exacerbation of COPD. However, the VIL–UME and IND–GLY combinations may confer slightly superior effectiveness than OLO–TIO on the risk of moderate or severe exacerbation. The potential lower mortality with VIL–UME warrants further investigation.