Differences in pulmonary function improvement after once-daily LABA/LAMA fixed-dose combinations in patients with COPD

Abstract Objective: This real-world study evaluated the efficacy of once-daily long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) for improving spirometry in patients with chronic obstructive pulmonary disease (COPD).Methods: We conducted this retrospective study at a single medical center in Taiwan from December 2014 to September 2020. Patients with COPD who were treated with once-daily LABA/LAMA FDCs for 12 months were enrolled. We evaluated their lung function improvement after 12 months treatment with different LABA/LAMA FDCs. Results: A total of 198 patients with COPD who were treated with once-daily LABA/LAMA FDCs were analyzed. A total of 114 patients were treated with umeclidinium/vilanterol (UMEC/VIL); 34 patients were treated with indacaterol/glycopyrronium (IND/GLY) and 50 patients were treated with tiotropium/olodaterol (TIO/OLO). The forced expiratory volume in 1 second (FEV1%) was significantly increased in the patients treated with all three once-daily FDCs (55.2% to 60.9%; Δ = 5.74%, p=0.012 for UMEC/VIL, 58.2% to 63.6%; Δ = 5.37%, p=0.023 for IND/GLY, and 54.1% to 57.7%; Δ = 3.61%, p=0.009 for TIO/OLO). Treatment of COPD patients with TIO/OLO resulted in a significant improvement in both forced vital capacity (FVC%) (71.7% to 77.9%; Δ = 6.16%, p=0.009) and residual volume (RV%) (180.1% to 152.5%; Δ = -27.55%, p<0.01) compared with those treated with UMEC/VIL (FVC%: 75.1% to 81.5%; Δ = 6.45%, p < 0.001; RV%:173.8% to 165.2%; Δ = -8.67%, p=0.231) or IND/GLY (FVC%: 73.9% to 79.3%; Δ = 5.42%, p = 0.08; RV%:176.8% to 168.3%; Δ =- 8.47%, p=0.589).Conclusions: Patients with COPD who were treated with different once-daily LABA/LAMA FDCs all had pulmonary lung function improvement in FEV1. Patients treated with UMEC/VIL or TIO/OLO showed better improvement in FVC compared to those treated with IND/GLY. On the other hand, those receiving TIO/OLO had better improvement in RV compared to those who received UMEC/VIL or IND/GLY.