Symbicort vs Advair.... which is best?

[Blossom/Jackie W.]

if you ask Astra Zeneca (the makers of Symbicort) they win; at least for COPD.

This was one of the rare times you see a study go head to head.... (please keep in mind this is a real world study)



Real-world study comparing commonly prescribed COPD medicines shows choice of treatment has impact on patient outcomes

MISSISSAUGA, ON, March 22, 2013 /CNW/ - PATHOS is the largest real-world study to compare the effectiveness of two commonly prescribed inhaled corticosteroid and long-acting beta agonist (ICS/LABA) combination treatments for chronic obstructive pulmonary disease (COPD) with more than one year of patient follow-up.1

An analysis of PATHOS data shows that COPD patients treated with SYMBICORT® (budesonide/formoterol) are significantly less likely to suffer from COPD-related exacerbations - or 'flare ups' - and are significantly less likely to be hospitalized for COPD than those treated with ADVAIR® (fluticasone/salmeterol).1

Overall, SYMBICORT® reduced the annual rate of moderate to severe exacerbations by 26 per cent compared to ADVAIR® (0.80 vs. 1.09 /patient-year; p<0.0001).1 The significant and clinically relevant reduction in favour of SYMBICORT® was apparent for all types of exacerbation events (e.g. antibiotic use, oral steroid use or hospital admission).1 Indeed, use of SYMBICORT® reduced rates of COPD-related hospitalization by 29 per cent (0.15 vs. 0.21 /patient-year; p<0.0001) with hospital days due to COPD exacerbation 34 per cent fewer (0.63 vs. 0.95/patient-year; p<0.0001) compared with ADVAIR®.1 This analysis of the PATHOS data was recently published in the Journal of Internal Medicine.1

"COPD is rapidly becoming one of the world's most serious health issues and is the fourth leading cause of death in Canada," said Dr. Charlie Chan, Professor and Vice-Chair of Medicine, University of Toronto, consultant Respirologist, University Health Network. "As a real-world evidence study, PATHOS plays an important role in helping healthcare professionals understand the impact of COPD treatment options on patient outcomes, and coupled with rigorous clinical trial data analysis, can provide a more fulsome picture of disease patterns patients are experiencing."

The 11-year PATHOS study, led by Uppsala University, retrospectively examined the medical records of 5,468* ICS/LABA-treated patients in Sweden from 1999 to 2009; comprising a total of 19,000 patient years.1 This first published analysis of the data compares the rate of COPD exacerbations associated with two commonly prescribed combinations.1 To allow for a valid comparison, a cohort of patients treated with SYMBICORT® were individually matched with an equal number of patients treated with a second ICS/LABA, ADVAIR®.1 Investigators used a statistical technique called "propensity score matching" to minimize bias and ensure the two ICS/LABA-treated groups were comparable in terms of variables including age, gender and measures of disease severity such as medication use, COPD co-morbidities, previous hospitalizations for any cause and exacerbation rates for COPD and other conditions like respiratory infections prior to the first ICS/LABA prescription.1 Exacerbations were defined in the study as medical interventions such as hospitalizations, emergency room visits and prescription of oral steroids or antibiotics due to COPD deterioration.1

The exacerbation findings published today are the first of several analyses of the PATHOS data. As a real-world evidence study, the findings show the impact of the two treatment combinations in clinical practice, providing healthcare providers, patients and payers with valuable information that can be used to inform their treatment decisions. PATHOS also collected data regarding rates of pneumonia events as the comparative safety measure, the evolution of COPD care during the 11-year period and how access to an asthma or COPD nurse impacts care. Analyses of these data are expected in subsequent publications.
more...... www.newswire.ca/en/story/1134139/real-world-study-comparing-commonly-prescribed-copd-medicines-shows-choice-of-treatment-has-impact-on-patient-outcomes

What are real-world evidence studies?

These studies examine how existing medicines and treatments are working in the health care system. Unlike controlled clinical trials, real-world evidence studies use observational data such as electronic medical records, insurance claims information and patient surveys. By examining data associated with the delivery of care, real-world analyses can assess how various treatments impact how long patients stay in the hospital, whether they are readmitted to the hospital, a patient’s overall health status, cost of care and other key evidence-based outcomes. more azhealthconnections.com/2011/02/08/az-qa-real-world-evidence-studies/




And.....
Just one little thing I want to add here.....
I believe this study was sponsored by Astra Zeneca.....

[Deleted]

It is a very interesting study. But you are correct it, was funded by AstraZeneca, and while that does not invalidate the study it does raise a question.

I have tried both Advair and Symbicort. I finally find Symbicort works better for me.

[Blossom/Jackie W.]

I use both as well Gerald. For me normally it's Symbicort but I resort to the Advair MDI (that way I can use a spacer) when I can't get a deep enough inhalation and breath hold for the turbohaler. I can't say for sure if one seems to work better than the other becasue when I use the Advair, I'm having problems to start with. However; I always go back to the Symbicort as soon as I can so maybe, just maybe, it does work better and I've never realized it.

What I DO wish is that we had the Symbicort in MDI form like they have in the States. That would make it so much easier and better.

[chrisw]

Another of life's imponderables. In Canada Symbicort is only available in the Turbuhaler, and in the US Advair is only available in the Discus.

[Deleted]

It is interesting that you are able to change back and forth. I just changed over and never tried mixing them. Only change since then is the Pulminary specialist doubled the dose of Symbicort.

I assist my Uncle in dealing with his affairs (he lives in Washington State) and I have noticed a lot of things in their medical system that would be nice to have up here. But I won't hold my breath for them.

[Blossom/Jackie W.]

They had me on it the first time Gerald when I was in the hospital 5 1/2 yrs ago; seems to me it was one of the MDI's that they'd use in the vent tube.... (Yeah; they spray them directly in ) so when I got out, I was still using it for a few more weeks. Then again 2 1/2 years ago.... that's what was used in place of Symbicort. So; ever since then I have a script on hand (PRN) for when I'm having an exacerbation and I can't do Symbicort.

I think the method of delivery per country has to do with patents Chris. I remember once talking with Astra Zeneca on an unrelated matter (and at that time Symbicort wasn't approved yet in the US I don't believe) and I happened to mention or ask why no Symbicort Turbohaler there.... Part of the delay, from what they told me, had to do with the design patent.

What dose and frequency of Symbicort are you on Gerald?

[wendyco]

just to throw my two cents worth in...besides delivery method, something is different in the meds.
Advair has serevent in it and Symbicort has foridal. I have a severe reaction to serevent but do not have the same with foridal. so Advair does the reverse on me, closes me instead of opening up and helping.....just food for thought

[Sue in Ontario]

Good Morning everyone,
My pulmonary dr too me off Symbicort 4yrs ago and put me on advair,reverse with md.so i take advair,i wonder if it is their preference!

[Deleted]

Jackie, I take Symbicort, 2 puffs twice daily. Originally they had increased it only during exacerbations, but they upped it to a regular usage.

Sue: I asked to change from Advair because it seemed to introduce arthritis into my hands. The doctors have seemed to prescribe what is newest, at least they did in the past. But I suspect that was because of the pharma companies hype and the fact they knew very little about the disease beyond the drug advertising.

[bonnielu]

Chris...I am in the US and have advair HFA....
I am thinking of trying the symbicort...

[Deleted]

to all and I have tried Advair and Spiriva and they don't help me however I just started Symbicort and it is working really good in that I don't use my Proventil near as often. I still can't do much work .

[Deleted]

I use spiriva with the symbicort. The spiriva does help, but it does not last 24 hours like the advertise. I agree, it is a challenge getting work done!!

[Blossom/Jackie W.]

there "tele" .... and welcome! For some, Advair works better; and for others Symbicort does. Good to hear you're having to use less of the Proventil. Do you have asthma btw?

Gerald; I'm curious how you know it's the Spiriva and not the Symbicort. Myself; I find the Symbicort doesn't go 12 hours ..... Spiriva's every 24 but it's supposedly active/good for 36 I believe.

[susanny]

I am another who closes up with the Advair. But rather than try Symbicort by pulmo went directly to the nebulizer using Duo Neb. I don't use the DuaNeb any more. I use Pulmicort and Brovana with some success. Wonder if that's the best there is or if something else might be better. What I don't like about the nebulizer is the amount of time it takes to get through all my meds, because I also use Albuteral and morphine in addition to the other two. It would be so much quicker to take with a hand held inhaler and more portable as well.

[Deleted]

Jackie: I usually take the Spriva and Symbicort first thing in the morning. A couple of times I have had to delay the spriva until later. My breathing is good at for a while and then shortness of breath starts about 5-6 hurs later. The spriva does help, for me it just doesn't last.