Can Assessment of Disease Burden Prior to Changes in Initial COPD Maintenance Treatment Provide Insight into Remaining Unmet Needs? A Retrospective Database Study in UK Primary Care.
This retrospective cohort study aimed to assess treatment patterns over 24 months amongst patients with chronic obstructive pulmonary disease (COPD), initiating a new COPD maintenance treatment, and to understand clinical indicators of treatment change. Patients included in the study initiated a long-acting β2-agonist (LABA), a long-acting muscarinic antagonist (LAMA), or a combination of LABA and an inhaled corticosteroid (ICS/LABA) between January 1, 2009, and November 30, 2013, as recorded in the United Kingdom Clinical Practice Research Datalink (UK CPRD). Treatment modifications (switching or adding maintenance treatments) over 24 months were assessed, and patient characteristics, disease burden, medication and healthcare resource use during the 30 days before treatment modification were evaluated. The cohort comprised 17,258 patients [LABA (8%), LAMA (39%) and ICS/LABA (54%)] with similar age, body mass index and dyspnoea distribution. LABA users were more likely than LAMA users to add a maintenance therapy. Distinct patterns of treatment augmentations were noted, whereby LABA users typically received dual therapy before moving to triple therapy, while LAMA users moved to triple therapy by directly adding an ICS/LABA. Exacerbation events immediately prior to treatment change were not frequently recorded; however, the need for rescue short-acting medication and assessment of dyspnoea in the 30 days prior to the treatment change suggest that dyspnoea is a remaining unmet need driving therapy change.
a Real World Evidence, GlaxoSmithKline R&D , Uxbridge , UK.
Sarah H
SH
Landis
b Real World Evidence, GlaxoSmithKline R&D , Upper Providence , PA , USA.
Keele
K
Wurst
c Health Economics & Real World Evidence, Parexel International , Durham , NC , USA.|d GlaxoSmithKline R&D, Research Triangle Park , NC , USA.
Hoa Van
HV
Le
a Real World Evidence, GlaxoSmithKline R&D , Uxbridge , UK.
Kerina
K
Bonar
e Value Evidence and Outcomes, GlaxoSmithKline R&D , Brentford , UK.
Yogesh S
YS
Punekar
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D018450:Disease Progression; D057915:Drug Substitution; D004359:Drug Therapy, Combination / Q000379:methods; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D018727:Muscarinic Antagonists
Chronic obstructive pulmonary disease; long-acting bronchodilators; retrospective cohort study; treatment modification; treatment switches