Abstract
Background
Cardiovascular disease is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). Concerns remain regarding safety and efficacy interactions in patients using both beta-blockers and inhaled long-acting beta-agonists.
Methods
In 16,485 patients with COPD and heightened cardiovascular risk who were randomized to once daily inhaled fluticasone furoate (FF), vilanterol (VI), their combination (FF/VI) or placebo, we assessed the effects of beta-blocker therapy usage on lung function, COPD exacerbations, cardiovascular events and all-cause mortality.
Results
The presence or absence of beta-blocker therapy resulted in no difference in the effect of VI alone versus placebo on post-bronchodilator FEV1 at 3 months (increases of 58 mL [95% confidence interval (CI) 38, 78] and 51 mL [95%CI 38, 65], respectively) or in the effect of FF/VI vs placebo with increases of 85 mL [95%CI 65, 105] and 68 mL [95%CI 54, 82] respectively).
Overall, there were no interactions by randomized treatment, including VI alone or in combination with FF, for COPD exacerbations, cardiovascular composite events and all-cause mortality.
Conclusions
Patients with COPD and heightened cardiovascular risk continue to receive respiratory benefit without an excess of cardiovascular risk from inhaled long-acting beta-agonist therapy regardless of beta-blocker therapy.
Cardiovascular disease is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD). Concerns remain regarding safety and efficacy interactions in patients using both beta-blockers and inhaled long-acting beta-agonists.
Methods
In 16,485 patients with COPD and heightened cardiovascular risk who were randomized to once daily inhaled fluticasone furoate (FF), vilanterol (VI), their combination (FF/VI) or placebo, we assessed the effects of beta-blocker therapy usage on lung function, COPD exacerbations, cardiovascular events and all-cause mortality.
Results
The presence or absence of beta-blocker therapy resulted in no difference in the effect of VI alone versus placebo on post-bronchodilator FEV1 at 3 months (increases of 58 mL [95% confidence interval (CI) 38, 78] and 51 mL [95%CI 38, 65], respectively) or in the effect of FF/VI vs placebo with increases of 85 mL [95%CI 65, 105] and 68 mL [95%CI 54, 82] respectively).
Overall, there were no interactions by randomized treatment, including VI alone or in combination with FF, for COPD exacerbations, cardiovascular composite events and all-cause mortality.
Conclusions
Patients with COPD and heightened cardiovascular risk continue to receive respiratory benefit without an excess of cardiovascular risk from inhaled long-acting beta-agonist therapy regardless of beta-blocker therapy.
| Original language | English |
|---|---|
| Journal | Annals of the American Thoracic Society |
| Volume | 15 |
| Issue number | 5 |
| Early online date | 1 May 2018 |
| DOIs | |
| Publication status | Published - 2018 |
