How do oral COPD treatments compare?

Investigators assessed new users of azithromycin and roflumilast with active COPD.

To compare the risk of moderate or severe COPD exacerbations between azithromycin and roflumilast in patients with active COPD.

Study Design: A target trial emulation using the Optum Clinformatics Data Mart Database to identify patients aged 40 and older who initiated maintenance azithromycin or roflumilast.
Patient Selection: Included patients had at least 183 days of continuous insurance enrollment and active COPD defined by specific claims criteria.
Outcome Measures: Moderate exacerbations required 5 to 14 days of oral glucocorticoid treatment; severe exacerbations required hospitalization.
Analysis: Primary analysis was as-treated with a median follow-up of 88 days and included 7,550 matched pairs.

Azithromycin was associated with a 17% lower likelihood of a first moderate or severe exacerbation compared to roflumilast.
Unadjusted incidence rates were 1.1 events per person-year for azithromycin and 1.3 for roflumilast.
Model-based 1-year risks were 60% for azithromycin and 67% for roflumilast.
Azithromycin also showed a 17% lower risk of a first moderate exacerbation and an 11% lower annual rate of moderate or severe exacerbations.