Analysis of Rescue Medication Use over 1 Year in Patients Receiving LAMA, LABA, or Combination Maintenance Treatment for COPD in the TONADO Studies
23 February 2017 (online)
In this analysis, we assessed the effect of prolonged use of a SABA (full agonist) as rm over time by comparing the rate of albuterol use (a) in the absence of a LABA (t) and when combined with LABA maintenance treatment (o or t+o).
5162 patients were randomized to once-daily t+o 2.5/5 or 5/5 mcg, t 2.5 or 5 mcg, or o 5 mcg, via the Respimat®, in 2 52-week, double-blind, parallel-group studies (NCT01431274; NCT01431287). Patients received a SABA inhaler (salbutamol/albuterol) for rm, as needed, and recorded the number of puffs used in an e-diary. We analyzed, post hoc, the mean yearly rates of change in daytime, nighttime, and daily (24-hour) SABA use using data combined from both studies.
Daily use of SABA rm increased over 1 year in patients receiving t by (mean [95% CI]) 0.49 (0.32, 0.65) daily puffs/year with t 5 mcg and 0.30 (0.13, 0.47) daily puffs/year with t 2.5 mcg. SABA use increased to a lesser extent with o 5 mcg: 0.22 (0.05, 0.39) daily puffs/year and was relatively unchanged with t+o 5/5 mcg: 0.15 (-0.02, 0.32) daily puffs/year and t+o 2.5/5 mcg: -0.01 (-0.18, 0.16) daily puffs/year. The rate of change in SABA use was significantly greater with t versus t+o and with t 5 mcg versus o. However, there was no significant difference in the yearly rate of change in SABA use in patients receiving o compared to those on t+o.
Patients using SABA rm alongside daily LAMA with t had an increase in SABA use over 1 year compared to those using SABA rm in addition to LABA or LAMA/LABA combination treatment. Given the established long-term efficacy profile of t, these findings suggest that prolonged unopposed use of a SABA without the partial agonist effects of LABA treatment may lead to tachyphylaxis and increased SABA use over time.
Content already presented at ATS congress 2016