{"title":"长效 B-2 激动剂 (LABA) 或长效毒蕈碱拮抗剂 (LAMA):A 组慢性阻塞性肺病患者的首选是哪一种?","authors":"Onur Turan, Nalan Ogan, Fulsen Bozkus, Nurhan Sarıoğlu, Pakize Ayşe Turan, Celal Satıcı","doi":"10.1007/s00228-024-03637-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Long-acting muscarinic antagonists (LAMA) or beta-2 agonists (LABA) have been recommended for symptom control in group A COPD patients as a first-line bronchodilator treatment in GOLD guidelines. However, there is no mention of priority/superiority between the two treatment options. We aimed to compare the effectiveness of these treatments in this group.</p><p><strong>Methods: </strong>The study cohort was formed of all subjects from six pulmonology clinics with an initial diagnosis of COPD who were new users of a LAMA or LABA from January 2020 to December 2021. Seventy-six group A COPD patients, in whom LABA or LAMA therapy had been started in the last 1 month as a first-line treatment, were included in our study. Participants were evaluated with spirometry, COPD Assessment Test (CAT), mMRC scale, and St. George Respiratory Questionnaire (SGRQ) for three times (baseline, 6-12<sup>th</sup> months).</p><p><strong>Results: </strong>There were 76 group A COPD patients with LAMA (67.1%) and LABA (32.9%). The number of patients who improved in CAT score at the end of the first year was significantly higher in patients using LAMA than those using LABA (p = 0.022); the improvement at minimum clinically important difference (MCID) in CAT score of LAMA group at 1<sup>st</sup> year was also significant (p = 0.044). SGRQ total and impact scores were found to be statistically lower at 1<sup>st</sup> year compared to baseline in patients using LAMA (p = 0.010 and 0.006, respectively). Significant improvement was detected in CAT and SGRQ scores at the 6<sup>th</sup> month visit in the LAMA group having emphysema (p = 0.032 and 0.002, respectively).</p><p><strong>Conclusion: </strong>According to significant improvements in CAT and SGRQ score, LAMA may be preferred over LABA as a bronchodilator agent in group A COPD patients, especially in emphysema-dominant phenotype.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Long-acting B-2 agonists (LABA) or long-acting muscarinic antagonists (LAMA): which one may be the first option in group A COPD patients?\",\"authors\":\"Onur Turan, Nalan Ogan, Fulsen Bozkus, Nurhan Sarıoğlu, Pakize Ayşe Turan, Celal Satıcı\",\"doi\":\"10.1007/s00228-024-03637-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Long-acting muscarinic antagonists (LAMA) or beta-2 agonists (LABA) have been recommended for symptom control in group A COPD patients as a first-line bronchodilator treatment in GOLD guidelines. However, there is no mention of priority/superiority between the two treatment options. We aimed to compare the effectiveness of these treatments in this group.</p><p><strong>Methods: </strong>The study cohort was formed of all subjects from six pulmonology clinics with an initial diagnosis of COPD who were new users of a LAMA or LABA from January 2020 to December 2021. Seventy-six group A COPD patients, in whom LABA or LAMA therapy had been started in the last 1 month as a first-line treatment, were included in our study. Participants were evaluated with spirometry, COPD Assessment Test (CAT), mMRC scale, and St. George Respiratory Questionnaire (SGRQ) for three times (baseline, 6-12<sup>th</sup> months).</p><p><strong>Results: </strong>There were 76 group A COPD patients with LAMA (67.1%) and LABA (32.9%). The number of patients who improved in CAT score at the end of the first year was significantly higher in patients using LAMA than those using LABA (p = 0.022); the improvement at minimum clinically important difference (MCID) in CAT score of LAMA group at 1<sup>st</sup> year was also significant (p = 0.044). SGRQ total and impact scores were found to be statistically lower at 1<sup>st</sup> year compared to baseline in patients using LAMA (p = 0.010 and 0.006, respectively). Significant improvement was detected in CAT and SGRQ scores at the 6<sup>th</sup> month visit in the LAMA group having emphysema (p = 0.032 and 0.002, respectively).</p><p><strong>Conclusion: </strong>According to significant improvements in CAT and SGRQ score, LAMA may be preferred over LABA as a bronchodilator agent in group A COPD patients, especially in emphysema-dominant phenotype.</p>\",\"PeriodicalId\":11857,\"journal\":{\"name\":\"European Journal of Clinical Pharmacology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Clinical Pharmacology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00228-024-03637-1\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Clinical Pharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00228-024-03637-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/23 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
简介:GOLD 指南建议将长效毒蕈碱拮抗剂(LAMA)或β-2 受体激动剂(LABA)作为一线支气管扩张剂治疗,用于控制 A 组慢性阻塞性肺疾病患者的症状。然而,指南中并未提及这两种治疗方案的优先性/优越性。我们旨在比较这两种治疗方法对该组患者的疗效:研究队列由来自六家肺科诊所、初次诊断为慢性阻塞性肺病、在 2020 年 1 月至 2021 年 12 月期间新使用 LAMA 或 LABA 的所有受试者组成。我们的研究纳入了76名A组慢性阻塞性肺病患者,他们在过去1个月内开始接受LABA或LAMA治疗,并将其作为一线治疗手段。对参与者进行了三次(基线、第 6-12 个月)肺量测定、慢性阻塞性肺病评估测试(CAT)、mMRC 量表和圣乔治呼吸问卷(SGRQ)评估:76名A组慢性阻塞性肺病患者使用了LAMA(67.1%)和LABA(32.9%)。使用LAMA的患者在第一年末CAT评分改善的人数显著高于使用LABA的患者(P = 0.022);LAMA组在第一年CAT评分的最小临床重要差异(MCID)改善也显著(P = 0.044)。与基线相比,使用 LAMA 的患者在第一年的 SGRQ 总分和影响得分在统计学上较低(p = 0.010 和 0.006)。有肺气肿的 LAMA 组患者在第 6 个月就诊时,CAT 和 SGRQ 分数有明显改善(p = 0.032 和 0.002):结论:根据CAT和SGRQ评分的明显改善,LAMA可能比LABA更适合作为A组慢性阻塞性肺病患者的支气管扩张剂,尤其是在肺气肿为主的表型中。
Long-acting B-2 agonists (LABA) or long-acting muscarinic antagonists (LAMA): which one may be the first option in group A COPD patients?
Introduction: Long-acting muscarinic antagonists (LAMA) or beta-2 agonists (LABA) have been recommended for symptom control in group A COPD patients as a first-line bronchodilator treatment in GOLD guidelines. However, there is no mention of priority/superiority between the two treatment options. We aimed to compare the effectiveness of these treatments in this group.
Methods: The study cohort was formed of all subjects from six pulmonology clinics with an initial diagnosis of COPD who were new users of a LAMA or LABA from January 2020 to December 2021. Seventy-six group A COPD patients, in whom LABA or LAMA therapy had been started in the last 1 month as a first-line treatment, were included in our study. Participants were evaluated with spirometry, COPD Assessment Test (CAT), mMRC scale, and St. George Respiratory Questionnaire (SGRQ) for three times (baseline, 6-12th months).
Results: There were 76 group A COPD patients with LAMA (67.1%) and LABA (32.9%). The number of patients who improved in CAT score at the end of the first year was significantly higher in patients using LAMA than those using LABA (p = 0.022); the improvement at minimum clinically important difference (MCID) in CAT score of LAMA group at 1st year was also significant (p = 0.044). SGRQ total and impact scores were found to be statistically lower at 1st year compared to baseline in patients using LAMA (p = 0.010 and 0.006, respectively). Significant improvement was detected in CAT and SGRQ scores at the 6th month visit in the LAMA group having emphysema (p = 0.032 and 0.002, respectively).
Conclusion: According to significant improvements in CAT and SGRQ score, LAMA may be preferred over LABA as a bronchodilator agent in group A COPD patients, especially in emphysema-dominant phenotype.
期刊介绍:
The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed.
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