Abstract
BACKGROUND: The optimal treatment strategy for chronic obstructive pulmonary disease (COPD) remains debated, especially when choosing between triple therapy and long-acting beta agonist (LABA) + long-acting muscarinic antagonist (LAMA). This study aimed to develop a model that simulates real-world prescription patterns and compares the effectiveness of these two treatment options. METHODS: This population-based cohort study used Taiwan's National Health Insurance Research Database to follow COPD patients who had been on LABA plus inhaled corticosteroids (ICSs) for more than 28 days. These patients were followed until they either upgraded to triple therapy or switched to LABA plus LAMA. The study enrolled patients from 2013 to 2021. Cox proportional hazard models were used to evaluate the risk of seven individual outcomes, including mortality, COPD exacerbations, acute respiratory failure, pneumonia, and respiratory-related admissions, adjusting for fixed and time-dependent variables. RESULTS: Among the 20,997 included patients (mean (standard deviation (SD)) age: 66.06 (11.54) years; 12,977 males (61.80%)), 16,792 (79.97%) were in the triple therapy group, and 4,205 (20.03%) were in LABA plus LAMA group. The triple therapy group showed significantly higher relative risks in several outcomes: composite outcome (adjusted hazard ratio (aHR): 1.162; 95% confidence interval (CI): 1.098 - 1.230; P < 0.0001), acute respiratory failure (aHR: 1.315; 95% CI: 1.047 - 1.653; P = 0.0186), severe acute exacerbation (aHR: 1.346; 95% CI: 1.078 - 1.682; P = 0.0088), pneumonia (aHR: 1.221; 95% CI: 1.109 - 1.344; P < 0.0001) and respiratory-related admission (aHR: 1.264; 95% CI: 1.157 - 1.382; P < 0.0001), indicating superior effectiveness of LABA plus LAMA in these indicators. CONCLUSIONS: In conclusion, in COPD patients, the combination of LABA plus LAMA can significantly improve many major symptoms and reduce the frequency of exacerbations.