| Summary: | This study investigates the effects of switching to different devices of the same active substance or between different active substances, in patients with Chronic Obstructive Pulmonary Disease (COPD) treated with Inhaled Corticosteroids (ICS) plus Long-acting β2-adrenergic agonists (LABAs) in terms of incidence of exacerbations. A retrospective cohort analysis, based on administrative databases of 3 Italian Local Health Units, was conducted. Patients with at least one prescription of a fixed dose combination of ICS/LABA from 1 January 2009 to 31 December 2011 were included. The index-date was defined as the earliest date within the inclusion period in which the patient had the first switch of drug or device (switchers) or the first prescription of ICS/LABA for patients continuing with the same treatment (non-switchers). Patients were observed until 31 December 2012. Propensity score matching was performed to check for cofounding effects. COPD exacerbations were defined as COPD-related hospitalization and prescription of corticosteroids and antibiotics. Number of: hospitalizations for COPD, oral corticosteroids and antibiotics prescriptions were analyzed using Poisson regression models. After matching, 1,759 patients per arm were analyzed. No statistically significant difference was found between study groups’. Incidence Rate Ratio in favor of non-switcher patients, as compared to switcher patients, was 1.41 (95% CI: 1.10–1.80) for number of hospitalizations, 1.05 (95% CI: 1.11–1.09) and 1.02 (95% CI: 0.96–1.09) for number of oral corticosteroids and antibiotics prescriptions, respectively. Our findings showed that switching to different devices of the same active substance or among different active substances in COPD patients treated with a fixed dose combination of ICS/LABA can lead to an higher likelihood of exacerbation COPD related rates than those who did not switch. Considering the study’s limitations, further studies are needed in order to confirm and enhance the generalizability of our findings.
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