title: Factors associated with early adherence to tiotropium in chronic obstructive pulmonary disease.
abstract: Tiotropium is an innovative intervention in chronic obstructive pulmonary disease (COPD). Early adherence to tiotropium remains inadequately explored, notably time from initiation to discontinuation (persistence). In patients with COPD, the factors associated with the risk of discontinuing the treatment with tiotropium within 12 months following initiation were identified (12-month persistence). Claim databases from the French Social Security were used. A random sample of patients (aged 50-80 years) who initiated tiotropium soon after launch was selected. Factors associated with the persistence were investigated (Log-rank test and multivariate Cox model). Of the 1147 newly treated patients (mean age 68 years, 33% women), 64% remained in the treatment of tiotropium for over a period of 12 months following initiation. More than 10% of the patients interrupted therapy after a single dispensing, most often those with mild COPD. Lower risks of discontinuing tiotropium within 12 months following initiation were observed when it was initiated by a private sector specialist (hazard ratio (HR) = 0.65, 95% confidence interval (CI) = (0.52-0.82)), by hospital-based physician (HR = 0.58, 95% CI = (0.42-0.78)), when ≥ 2 other respiratory drugs were associated (HR = 0.74, 95% CI = (0.58-0.95)) and in case of long-term disease status (HR = 0.78, 95% CI = (0.63-0.97)). Conversely, no clear effect appeared according to age or gender. In this population of patients with COPD, fewer early discontinuations of tiotropium were observed in patients having a severe condition.
authors.affiliation: Unité de Pharmacoépidémiologie, CHU-Lyon, d'Odontologie - UMR 5558 CNRS - Université Claude Bernard Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Laforest
authors.forename: Idlir
authors.initials: I
authors.lastname: Licaj
authors.forename: Gilles
authors.initials: G
authors.lastname: Devouassoux
authors.forename: Susanne
authors.initials: S
authors.lastname: Hartwig
authors.forename: Serge
authors.initials: S
authors.lastname: Marvalin
authors.forename: Eric
authors.initials: E
authors.lastname: Van Ganse
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage; D016208:Databases, Factual / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000145:classification / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D011897:Random Allocation; D012307:Risk Factors; D012602:Scopolamine Derivatives / Q000008:administration & dosage*; D012720:Severity of Illness Index; D012737:Sex Factors; D000069447:Tiotropium Bromide; D016903:Drug Monitoring
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide