Effectiveness of Fluticasone Furoate-Vilanterol for COPD in Clinical Practice.
Evidence for the management of chronic obstructive pulmonary disease (COPD) comes from closely monitored efficacy trials involving groups of patients who were selected on the basis of restricted entry criteria. There is a need for randomized trials to be conducted in conditions that are closer to usual clinical practice.



In a controlled effectiveness trial conducted in 75 general practices, we randomly assigned 2799 patients with COPD to a once-daily inhaled combination of fluticasone furoate at a dose of 100 μg and vilanterol at a dose of 25 μg (the fluticasone furoate-vilanterol group) or to usual care (the usual-care group). The primary outcome was the rate of moderate or severe exacerbations among patients who had had an exacerbation within 1 year before the trial. Secondary outcomes were the rates of primary care contact (contact with a general practitioner, nurse, or other health care professional) and secondary care contact (inpatient admission, outpatient visit with a specialist, or visit to the emergency department), modification of the initial trial treatment for COPD, and the rate of exacerbations among patients who had had an exacerbation within 3 years before the trial, as assessed in a time-to-event analysis.



The rate of moderate or severe exacerbations was significantly lower, by 8.4% (95% confidence interval, 1.1 to 15.2), with fluticasone furoate-vilanterol therapy than with usual care (P=0.02). There was no significant difference in the annual rate of COPD-related contacts to primary or secondary care. There were no significant between-group differences in the rates of the first moderate or severe exacerbation and the first severe exacerbation in the time-to-event analyses. There were no excess serious adverse events of pneumonia in the fluticasone furoate-vilanterol group. The numbers of other serious adverse events were similar in the two groups.



In patients with COPD and a history of exacerbations, a once-daily treatment regimen of combined fluticasone furoate and vilanterol was associated with a lower rate of exacerbations than usual care, without a greater risk of serious adverse events. (Funded by GlaxoSmithKline; Salford Lung Study ClinicalTrials.gov number, NCT01551758 .).
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Jørgen
J
Vestbo
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
David
D
Leather
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Nawar
N
Diar Bakerly
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
John
J
New
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
J Martin
JM
Gibson
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Sheila
S
McCorkindale
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Susan
S
Collier
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Jodie
J
Crawford
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Lucy
L
Frith
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Catherine
C
Harvey
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Henrik
H
Svedsater
From the Centre for Respiratory Medicine and Allergy, Manchester Academic Health Sciences Centre, University of Manchester and University Hospital of South Manchester NHS Foundation Trust (J.V., A.W.), Manchester Academic Health Sciences Centre, University of Manchester and Salford Royal NHS Foundation Trust (J.M.G.), and NIHR Clinical Research Network Greater Manchester (S.M.), Manchester; Global Respiratory Franchise (D.L.) and Respiratory Research and Development (S.C., J.C., L.F., H.S.), GlaxoSmithKline UK, Brentford; Salford Royal NHS Foundation Trust (N.D.B., J.N., J.M.G.), NorthWest EHealth (J.N., J.M.G.), and NHS Salford Clinical Commissioning Group (S.M.), Salford; and Global Clinical Safety and Pharmacovigilance, Safety Evaluation and Risk Management, GlaxoSmithKline UK, Uxbridge (C.H.) - all in the United Kingdom.
Ashley
A
Woodcock
D000280:Administration, Inhalation; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D001592:Benzyl Alcohols / Q000008:administration & dosage* / Q000009:adverse effects; D002722:Chlorobenzenes / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
D000730:Androstadienes; D001592:Benzyl Alcohols; D002722:Chlorobenzenes; D004338:Drug Combinations; D005938:Glucocorticoids; C550468:vilanterol; C523187:fluticasone furoate