Vogelmeier CF, et al. - Researchers compared once-daily indacaterol/glycopyrronium (IND/GLY) 110/50 µg with twice-daily salmeterol/fluticasone (SFC) 50/500 µg in symptomatic patients with moderate to very severe COPD and a history of exacerbations in the previous year. Consistent beneficial effects were noted with IND/GLY vs SFC on moderate/severe exacerbations, independent of prior exacerbation history or treatment. For exacerbations treated with antibiotics with/without systemic corticosteroids, the efficacy of IND/GLY on exacerbation prevention was superior to SFC and was similar for exacerbations treated with systemic corticosteroids alone.

Methods

• Experts conducted a prespecified and post hoc subgroup analysis.
• They assessed treatment effectiveness on moderate/severe exacerbations according to prior exacerbation history and treatment, and types of exacerbations according to health care resource utilization (HCRU) during 1-year follow-up.

Results

• Results demonstrated IND/GLY to reduce the rate of moderate/severe exacerbations vs SFC in patients with a history of 1 exacerbation (rate ratio [RR]: 0.83, 95% CI: 0.75-0.93), ≥2 exacerbations (RR: 0.85, 95% CI: 0.70–1.03) and ≥2 exacerbations or ≥1 hospitalization in the previous year (RR: 0.86, 95% CI: 0.74-1.00).
• According to exacerbation history, prolonged time-to-first exacerbation was observed in all the groups. 
• As per data, independent of previous treatment, moderate/severe exacerbations decreased with IND/GLY vs SFC.
• The rates of moderate/severe exacerbations treated with antibiotics (RR: 0.79, 95% CI: 0.67–0.93) and systemic corticosteroids and antibiotics (RR: 0.80, 95% CI: 0.70–0.91) were significantly reduced by IND/GLY.
• Findings suggested the rates of exacerbations treated with systemic corticosteroids alone to be comparable (RR: 0.99, 95% CI: 0.80-1.22).