Comparing a fixed combination of budesonide/formoterol with other inhaled corticosteroid plus long-acting beta-agonist combinations in patients with chronic obstructive pulmonary disease: a review

ABSTRACT

Introduction: Inhaled corticosteroid (ICS) plus long-acting β₂-agonist (LABA) combinations are commonly used in the treatment of patients with chronic obstructive pulmonary disease (COPD). At least four fixed-dose ICS/LABA combinations are available, including budesonide/formoterol, beclomethasone/formoterol, fluticasone/vilanterol and fluticasone/salmeterol, but there is little guidance for clinicians on which of these combinations to prescribe.

Areas covered: The aim of this in-depth review was to identify studies that compared budesonide/formoterol with the other ICS/LABA combinations and assess the data on exacerbations, safety, and patient quality of life. PubMed and Ovid databases were searched, and 14 studies were identified. Our findings highlight the lack of prospective, randomized, controlled trials comparing LABA/ICS combinations in the treatment of COPD as only two such studies were identified. However, current evidence suggests that the effects of budesonide/formoterol on reducing exacerbations and improving quality of life may be similar to, or more marked than, those of other LABA/ICS combinations in COPD and, compared with the other LABA/ICS combinations, budesonide/formoterol may be associated with a lower incidence of serious pneumonia events and oral candidiasis.

Expert opinion: To better guide clinicians in selecting between the available ICS/LABA, robust meta-analyses and well-designed head-to-head clinical trials are urgently needed.

KEYWORDS:

• Chronic obstructive pulmonary disease
• fixed-dose combinations
• inhaled corticosteroids
• long-acting β₂-agonists
• COPD
• pneumonia

Article highlights

• Our comprehensive literature search found only 14 studies for inclusion in this in-depth review comparing budesonide/formoterol with other fixed-dose ICS/LABA combinations.

• Based on limited evidence, the effectiveness of budesonide/formoterol in reducing exacerbations and improving quality of life in patients with COPD was similar to or better than other fixed-dose ICS/LABA combinations.

• Budesonide/formoterol may be associated with a lower incidence of pneumonia and oral candidiasis.

• There remains a lack of prospective studies of fixed-dose ICS/LABA combinations to aid clinicians in decision-making when prescribing such treatment for COPD patients and this should be considered an important area of future research.

Acknowledgments

We would like to thank Catherine Rees and Georgii Filatov, of Springer Healthcare Communications, for writing the outline and first draft of this manuscript, respectively. This medical writing assistance was funded by AstraZeneca (Milan, Italy), in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

P Solidoro, F Patrucco and D Bagnasco aided in interpreting the results and worked on the manuscript. All authors discussed the results and commented on the manuscript.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.