Journal Article

A Cohort Study to Evaluate the Risk of Hospitalisation for Congestive Heart Failure Associated with the Use of Aclidinium and Other Chronic Obstructive Pulmonary Disease Medications in the UK Clinical Practice Research Datalink

Lei, Alejhandra, Rivero-Ferrer, Elena, Rubino, Annalisa, Saigi-Morgui, Nuria, Aguado, Jaume, Daoud, Sami, Plana, Estel, Rebordosa, Cristina, Perez-Gutthann, Susana

2021

Overview

The long-acting anticholinergic (LAMA) aclidinium was approved in Europe in 2012 to relieve symptoms in adults with chronic obstructive pulmonary disease (COPD). A Post-Authorisation Safety Study (PASS) was initiated to assess potential cardiovascular safety concerns for aclidinium. To estimate the adjusted incidence rate ratio (IRR) for hospitalisation for heart failure in patients with COPD who were new users of aclidinium, tiotropium, other LAMA, long-acting beta-agonists/inhaled corticosteroids (LABA/ICS), and LAMA/LABA were compared with initiators of LABA. This population-based cohort study included patients with COPD aged ≥40 years initiating COPD medications in the Clinical Practice Research Datalink (CPRD) GOLD in the United Kingdom from 2012 to 2017. Medications were identified via general practice prescriptions. The first-ever hospitalisations for heart failure were identified in the Hospital Episode Statistics, and general practitioner records from the CPRD. Poisson regression models were used to estimate the IRR for hospitalisation for heart failure in users of COPD medications versus LABA, adjusting for clinically relevant covariates. The study included 4350 new users of aclidinium, 23,405 of tiotropium, 6977 of other LAMAs, 3122 of LAMA/LABA, 26,093 of LABA/ICS, and 5678 of LABA. Mean age was 69-70 years across medication groups. Aclidinium users had the highest proportion of severe COPD, and LABA users had the lowest (35% vs 19%, respectively). Crude incidence rates per 1000 person-years for the first-ever hospitalisation for heart failure ranged from 6.9 in LABA to 9.5 in aclidinium. Using LABA as reference, adjusted IRRs (95% confidence interval) for first-ever hospitalisation for heart failure were 0.90 (0.53-1.53) for aclidinium, 1.02 (0.69-1.51) for tiotropium, 0.86 (0.50-1.47) for other LAMAs, 1.09 (0.41-2.92) for LAMA/LABA, and 1.01 (0.69, 1.48) for LABA/ICS. The study did not find increased risks of hospitalisations for heart failure in new users of aclidinium, tiotropium, other LAMAs, LAMA/LABA, and LABA/ICS compared with LABA.

• Publisher: Dove Medical Press Limited,Dove Medical Press Ltd,Dove Press,Dove,Dove Medical Press
• Subject: aclidinium / Aclidinium bromide / Administration, Inhalation / Adrenal Cortex Hormones - therapeutic use / Adrenergic beta-2 Receptor Agonists - adverse effects / Adult / Aged / Asthma / Body mass index / Bronchodilator Agents - adverse effects / Cardiac patients / Chronic obstructive pulmonary disease / Clinical medicine / Cohort analysis / Cohort Studies / Coma / Comparative analysis / Congenital diseases / Drug Therapy, Combination / Europe - epidemiology / Family medicine / Heart failure / Heart Failure - chemically induced / Heart Failure - diagnosis / Heart Failure - drug therapy / HIV / Hospitalization / Human immunodeficiency virus / Humans / Immune system / Indacaterol / Ischemia / Kidney diseases / LAMA / Lung diseases, Obstructive / Medical research / Medicine, Experimental / Mortality / Muscarinic Antagonists - adverse effects / Original Research / Patients / Pharmaceutical industry / Practice research / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - drug therapy / Pulmonary Disease, Chronic Obstructive - epidemiology / Regulatory approval / Tiotropium / United Kingdom / United Kingdom - epidemiology