{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:23:04Z","timestamp":1793215384818,"version":"4.5.0"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 110-2320-B-A49A-534"],"award-info":[{"award-number":["MOST 110-2320-B-A49A-534"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Respir Dis"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      The latest guidelines discourage the use of long-acting beta\n                      <jats:sub>2<\/jats:sub>\n                      -agonists\/inhaled corticosteroids (LABA\/ICS) for chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the optimal subsequent treatment after discontinuing LABA\/ICS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare the effectiveness and safety of switching from LABA\/ICS to triple therapy (LABA\/long-acting muscarinic antagonists (LAMA)\/ICS) or to dual bronchodilators (LABA\/LAMA) in COPD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This was a new-user, active-comparator, and propensity score-matched cohort study analyzing the Taiwanese nationwide healthcare insurance claims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We recruited COPD patients switching from LABA\/ICS to triple therapy or to dual bronchodilators from 2015 to 2019. The primary effectiveness outcome was the annual rate of exacerbations, and safety outcomes included severe pneumonia and all-cause mortality. Stratification by prior exacerbations was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After matching, each group comprised 1892 patients, 55% of whom experienced no exacerbations in the prior year. Treatment with LABA\/LAMA\/ICS versus LABA\/LAMA showed comparable annual rate of moderate-to-severe exacerbations (incidence rate ratio, 1.04; 95% confidence interval (CI), 0.91\u20131.19). However, switching to LABA\/LAMA\/ICS was associated with increased risks of severe pneumonia (hazard ratio (HR), 1.65; 95% CI, 1.30\u20132.09) and all-cause death (HR, 1.39; 95% CI, 1.09\u20131.78). In patients with\u2a7e2 prior exacerbations, LABA\/LAMA\/ICS versus LABA\/LAMA was related to a 21% reduced rate of exacerbations but with a twofold increased pneumonia risk and a 49% elevated risk of all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Switching from LABA\/ICS to triple therapy versus dual bronchodilators in COPD patients was associated with similar rates of annual exacerbations but was related to elevated risks of severe pneumonia and all-cause mortality. Among frequent exacerbators, triple therapy was associated with lower rates of exacerbation but was accompanied by increased risks of pneumonia and mortality compared to LABA\/LAMA. Careful consideration of the examined safety events is necessary when switching from LABA\/ICS to triple therapy in COPD management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17534666241292242","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T01:16:42Z","timestamp":1730683002000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative effectiveness and safety of escalating to triple therapy versus switching to dual bronchodilators after discontinuing LABA\/ICS in patients with COPD: a retrospective cohort study"],"prefix":"10.1177","volume":"18","author":[{"given":"Li-Wei","family":"Wu","sequence":"first","affiliation":[{"name":"School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu-Chieh","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu-Han","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Jay","family":"Liou","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China"},{"name":"Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Liang","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-980X","authenticated-orcid":false,"given":"Kuang-Yao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan 11217, Republic of China"},{"name":"Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2153-6632","authenticated-orcid":false,"given":"Meng-Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan 8267250, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,11,3]]},"reference":[{"issue":"069679","key":"bibr1-17534666241292242","first-page":"1","volume":"378","author":"Safiri S","year":"2022","journal-title":"BMJ"},{"key":"bibr2-17534666241292242","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"bibr3-17534666241292242","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2011-200768"},{"key":"bibr4-17534666241292242","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. 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