The Effect on Total Mortality of Adding Inhaled Corticosteroids to Long-Acting Bronchodilators for XXXX : A Real Practice Analysis in Italy.

@entity1 @entity4185 @entity1030
PURPOSE: Chronic therapy with long-acting bronchodilators (LB) is recommended to treat moderate-to-severe @entity1030 . Although the benefits of adding @entity4185 ( @entity4185 ) to LB are still unclear, @entity1 who experience repeated exacerbations are suggested to add @entity4185 to their LB treatment. The objective of this study is to analyze whether adding @entity4185 to LB therapy reduces mortality. METHODS: We identified a cohort of @entity1 discharged from hospital with @entity1030 diagnosis between 2006 and 2009. The first prescription for LB or @entity4185 following discharge was defined as the index prescription. Only new users were included (no use of any study drug in the 6 months before treatment). A 4-day time window was used to classify @entity1 into "LB alone" or "LB plus @entity4185 " initiators. We used propensity score to balance the study groups. Sensitivity analyses were performed in @entity1 with recent out-of-hospital exacerbations. RESULTS: Among the 18615 adults enrolled, 12207 initiated "LB plus @entity4185 " therapy and 6408 "LB alone." Crude mortality rates were 110 and 143 cases per 1000 @entity1 -years in the "LB plus @entity4185 " and "LB alone" groups, respectively. The adjusted hazard ratio (HR) was 0.83 (95% CI: 0.72-0.97; p-value: 0.024). When analyzing @entity1 with recent out-of-hospital exacerbations, the benefit of the combination therapy was more pronounced, HR = 0.63 (95% CI: 0.44-0.90; p-value: 0.012). DISCUSSION: Our findings showed a beneficial effect on mortality of adding inhaled corticosteroids to long-acting bronchodilators. The advantage was much more pronounced in @entity1 with frequent exacerbations.
