Comparative effectiveness of fixed-dose inhaled corticosteroid/long-acting beta-agonist therapy in adult patients with asthma.

BACKGROUND

Inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA) therapy is a mainstay of asthma management, yet real-world comparative evidence across different formulations remains limited.

OBJECTIVE

To compare the effectiveness of prescribed fixed-dose ICS/LABA combinations in reducing moderate-to-severe asthma exacerbations (MSAEs) among adults, stratified by initial ICS dose.

METHODS

This retrospective cohort study used data from Taiwan's National Health Insurance Research Database and Cause of Death Registry (2016-2021). Adults with asthma who initiated fixed-dose ICS/LABA therapy between 2017 and 2020 were included. Treatment groups comprised budesonide/formoterol (reference), extrafine beclometasone dipropionate/formoterol, fluticasone propionate/salmeterol, and fluticasone furoate/vilanterol. Patients were stratified by initial ICS dosage into low-dose and medium-to-high-dose cohorts. Risk of MSAE was assessed using Cox proportional hazards model with inverse probability of treatment weighting for covariate adjustment.

RESULTS

Among 128,426 eligible patients, 35,532 were in the low-dose and 88,954 in the medium-to-high-dose cohort. In the low-dose cohort, extrafine beclometasone dipropionate/formoterol (hazard ratio [HR]: 0.97, 95% CI: 0.88-1.09) and fluticasone propionate/salmeterol (HR: 1.16, 95% CI: 0.98-1.37) had a similar risk of MSAE compared with budesonide/formoterol. In the medium-to-high-dose cohort, fluticasone furoate/vilanterol was associated with a slightly lower MSAE risk compared with budesonide/formoterol (HR: 0.92, 95% CI: 0.86-0.97), particularly in those with prior exacerbations (HR: 0.84, 95% CI: 0.77-0.91). Extrafine beclometasone dipropionate/formoterol (HR: 0.96, 95% CI: 0.89-1.04) and fluticasone propionate/salmeterol (HR: 1.06, 95% CI: 0.98-1.15) had no significant difference.

CONCLUSION

The findings suggest that fluticasone furoate/vilanterol may offer a potential advantage for asthma management compared with other fixed-dose ICS/LABA combinations.