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Observational study on the impact of initiating tiotropium alone versus tiotropium with fluticasone propionate/salmeterol combination therapy on outcomes and costs in chronic obstructive pulmonary disease Arjun Chatterjee1*, Manan Shah2, Anna O D'Souza2, Benno Bechtel3, Glenn Crater3 and Anand A Dalal3
Respiratory Research 2012, 13:15 doi:10.1186/1465-9921-13-15
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BPCO : Mieux avec un traitement combinél
La triple association d'un corticoïde inhalé, d'un bêta-agoniste longue durée et d'un anti-cholinergique a prouvé au cours d'études cliniques sa supériorité par rapport à un anti-cholinergique utilisé seul, pour l'amélioration de la fonction respiratoire, de la qualité de vie et la réduction des hospitalisations. La trithérapie est associée à une diminution de 23 % du risque total d'exacerbations et de 24 % de celui d'exacerbations de gravité moyenne. Le bénéfice de l'association n'est toutefois pas statistiquement significatif pour les exacerbations sévères, bien qu'il semble exister une tendance à la réduction du risque dans ce cas aussi.

Background
This retrospective cohort study compared the risks of exacerbations and COPD-related healthcare costs between patients with chronic obstructive pulmonary disease (COPD) initiating tiotropium (TIO) alone and patients initiating triple therapy with fluticasone-salmeterol combination (FSC) added to TIO.

Methods
Managed-care enrollees who had an index event of = 1 pharmacy claim for TIO during the study period (January 1, 2003-April 30, 2008) and met other eligibility criteria were categorized into one of two cohorts depending on their medication use. Patients in the TIO+FSC cohort had combination therapy with TIO and FSC, defined as having an FSC claim on the same date as the TIO claim. Patients in the TIO cohort had no such FSC use. The risks of COPD exacerbations and healthcare costs were compared between cohorts during 1 year of follow-up.

Results
The sample comprised 3333 patients (n = 852 TIO+FSC cohort, n = 2481 TIO cohort). Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation (hazard ratio 0.772; 95% confidence interval [CI] 0.641, 0.930) and any exacerbation (hazard ratio 0.763; 95% CI 0.646, 0.949) and a nonsignificant reduction in COPD-related adjusted monthly medical costs.

Conclusions
Triple therapy with FSC added to TIO compared with TIO monotherapy was associated with significant reductions in the adjusted risks of moderate exacerbation and any exacerbation over a follow-up period of up to 1 year. These improvements were gained with triple therapy at roughly equal cost of that of TIO alone.

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