{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:07:22Z","timestamp":1790870842597,"version":"4.1.0"},"reference-count":56,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-ioi250100-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>\n                      Dual bronchodilator therapy with a long-acting muscarinic antagonist (LAMA) and a long-acting \u03b2\n                      <jats:sub>2<\/jats:sub>\n                      -agonist (LABA) is recommended for most patients with symptomatic chronic obstructive pulmonary disease (COPD). Fixed-dose LAMA-LABA therapies are available in metered-dose, dry powder, and soft mist inhalers. However, metered-dosed inhalers are associated with greater greenhouse gas emissions than either dry powder or soft mist inhalers, and questions persist about potential intraclass differences among LAMA-LABAs given variability in their active ingredients, dosing schedules, and delivery devices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250100-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the comparative effectiveness and safety of once-daily umeclidinium-vilanterol dry powder inhalers, twice-daily glycopyrrolate-formoterol metered-dosed inhalers, and once-daily tiotropium-olodaterol soft mist inhalers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250100-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This observational active-comparator study analyzed claims of patients (\u226540 years) newly treated with LAMA-LABA inhalers and continuously enrolled in a large commercial health insurance or Medicare Advantage plan during the 183-day baseline period. Patients were propensity score matched 1:1 into 3 cohorts with index dates ranging from May 1, 2016, to February 28, 2025. Data were analyzed from July to August 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250100-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Patients treated with umeclidinium-vilanterol, glycopyrrolate-formoterol, or tiotropium-olodaterol fixed-dose inhalers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250100-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Time to the first moderate or severe COPD exacerbation, major adverse cardiovascular event, urinary tract infection, and pneumonia hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250100-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohorts included 9479 matched pairs of patients receiving umeclidinium-vilanterol vs glycopyrrolate-formoterol (mean age, 68.9 [SD, 9.0] years; 10\u202f319 women [54.4%]; 8636 men [45.6%]), 9598 receiving tiotropium-olodaterol vs glycopyrrolate-formoterol (mean age, 69.2 [SD, 8.7] years; 10\u202f513 women [54.8%]; 8680 men [45.2%]), and 36\u202f740 receiving umeclidinium-vilanterol vs tiotropium-olodaterol (mean age, 71.5 [SD, 8.4] years; 39\u202f429 women [53.7%]; 34\u202f044 men [46.3%]). Umeclidinium-vilanterol was associated with a 14% lower hazard of a first moderate or severe COPD exacerbation than glycopyrrolate-formoterol (hazard ratio [HR], 0.86; 95% CI, 0.81-0.91; number needed to treat [NNT], 17) and was associated with a 3% lower hazard than tiotropium-olodaterol (HR, 0.97; 95% CI, 0.94-0.99; NNT, 100). Tiotropium-olodaterol was associated with a 6% lower hazard of a first moderate or severe COPD exacerbation than glycopyrrolate-formoterol (HR, 0.94; 95% CI, 0.89-1.00). Similar risks of first major adverse cardiovascular event, urinary tract infection, and pneumonia hospitalization were observed among patients in all 3 cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250100-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This cohort study found that umeclidinium-vilanterol was associated with improved clinical outcomes compared with glycopyrrolate-formoterol and tiotropium-olodaterol. Patients, prescribers, and health systems may consider once-daily umeclidinium-vilanterol dry powder inhalers over alternatives among new users of LAMA-LABA therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.8087","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T16:30:37Z","timestamp":1771864237000},"page":"456","source":"Crossref","is-referenced-by-count":5,"title":["Comparative Effectiveness and Safety of LAMA-LABA Inhalers in Chronic Obstructive Pulmonary Disease"],"prefix":"10.1001","volume":"186","author":[{"given":"Gerard T.","family":"Portela","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley 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