Evidence map›Paper›PMID 40367410›Full record

ArticlePLoS medicine2025

The comparative effectiveness and safety of fluticasone-salmeterol via metered-dose versus dry powder inhalers for COPD: A new user cohort study.

Brandon J Demkowicz, Kevin Rader, Shirley V Wang, Aaron S Kesselheim, William B Feldman

Abstract readComparative Study
In one paragraph

Article in PLoS medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Brandon J DemkowiczDepartment of Statistics, Harvard University, Cambridge, Massachusetts, United States of America.ORCID https://orcid.org/0000-0002-0107-8032
Kevin RaderDepartment of Statistics, Harvard University, Cambridge, Massachusetts, United States of America.ORCID https://orcid.org/0009-0002-7793-8075
Shirley V WangProgram on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Aaron S KesselheimProgram on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.ORCID https://orcid.org/0000-0002-8867-2666
William B FeldmanProgram on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.ORCID https://orcid.org/0000-0003-3467-5869

Funding

Improving COPD Outcomes: Using Real-World Data to Analyze Treatment Effectiveness, Safety, and AdherenceK08HL163246 · NHLBI · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI William Brand Feldman · 2023 to 2026
$643k
NHLBI NIH HHS K08 HL163246
6 · The paper itself

Abstract

backgroundFluticasone-salmeterol is available in both metered-dose and dry powder inhaler formulations for the treatment of chronic obstructive pulmonary disease (COPD). Metered-dose inhalers are associated with substantially higher greenhouse gas emissions than dry powder inhalers; however, data on their comparative effectiveness and safety in COPD remain limited. We aimed to compare the effectiveness and safety of fluticasone-salmeterol delivered via metered-dose inhaler (Advair HFA) versus dry powder inhaler (Advair Diskus) among patients with COPD treated in routine care. METHODS AND

findingsWe conducted a retrospective cohort study using Optum's de-identified Clinformatics DataMart (January 1, 2007 to November 30, 2023). The study included 202,052 commercially insured patients aged 40 years or older with COPD who had continuous insurance coverage for 180 days prior to cohort entry and had not initiated any inhaled corticosteroid-long-acting β₂-agonist during that period. Patients receiving fluticasone-salmeterol via a metered-dose inhaler (exposure) were compared to those receiving these drugs via a dry powder inhaler (referent), with stabilized inverse probability of treatment weighting applied for covariate adjustment. The primary effectiveness outcome was the incidence of first moderate or severe COPD exacerbation within 365 days of cohort entry. The primary safety outcome was the incidence of first pneumonia hospitalization during the same period. Use of fluticasone-salmeterol via metered-dose inhaler was associated with a similar hazard of first moderate or severe COPD exacerbation (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.99 to 1.08) and first pneumonia hospitalization (HR, 1.06; 95% CI, 0.98 to 1.14) compared to the dry powder inhaler. Primary study limitations include potential residual confounding despite weighting and short follow-up times.

conclusionsIn this cohort study comparing two brand-name fluticasone-salmeterol inhalers prescribed for COPD in routine clinical practice, effectiveness and safety outcomes were similar for patients receiving metered-dose and dry powder versions.

Indexed as

Bronchodilator AgentsDry Powder InhalersFluticasone-Salmeterol Drug CombinationMetered Dose InhalersPulmonary Disease, Chronic ObstructiveAdministration, InhalationAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeBronchodilator AgentsFluticasone-Salmeterol Drug Combination

Identifiers

PMID40367410
PMCPMC12077913

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.