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

Landis, Sarah H.; Wurst, Keele; Le, Hoa Van; Bonar, Kerina; Punekar, Yogesh Suresh

doi:10.1080/15412555.2016.1240159

Cited by 12 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding suggests that the assessment of dyspnea, a cardinal symptom of COPD, may not be well integrated into daily practice, perhaps owing to the difficulty for GPs to clinically appreciate this primary indicator. Other observational studies identified comorbid asthma, high exacerbation rates, airflow obstruction, and comorbidities as determinants of initial maintenance therapy,40 whereas a retrospective database study in UK primary care reported only a minor role of exacerbations in treatment modifications (switching or augmenting maintenance therapy) 24. In addition, ~50% of patients who started an initial maintenance treatment with LABD therapy in our study did so in combination with ICS.…”

Section: Discussioncontrasting

confidence: 49%

“…With multiple classes of drugs now available for the pharmacological treatment of COPD in France, the treatment armamentarium available to clinicians has expanded; however, these options have reintroduced instability and uncertainty regarding treatment pathways in COPD. For example, a recently published retrospective cohort study set within UK primary care showed differential patterns of escalation and switch, with multiple pathways for escalating to triple therapy 24…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners

Meeraus

Wood

Jakubanis

et al. 2018

COPD

View full text Add to dashboard Cite

BackgroundIncreasing availability of therapeutic options for COPD may drive new treatment pathways. This study describes COPD treatment in France, focusing on identifying initial treatment modifications in patients with COPD who either initiated long-acting bronchodilator (LABD)-based therapy or escalated to triple therapy (long-acting muscarinic antagonist [LAMA] + long-acting β2-agonist [LABA] + inhaled corticosteroid [ICS]).MethodsThis retrospective analysis of patients with COPD in a large general practitioner database (IQVIA Longitudinal Patient Database) in France included two cohorts: Cohort 1 – new initiators of LABD-based therapy (LAMA, LABA, LAMA + LABA, LAMA + ICS, LABA + ICS or LAMA + LABA + ICS); Cohort 2 – patients escalating to triple therapy from mono- or dual-bronchodilator-based maintenance treatment. Both cohorts were indexed on the date of initiation/escalation (January 2008–December 2013), and the first treatment modification (at class level) within the 18-month post-index observational period was described. Five mutually exclusive outcomes were defined: continuous use (no modification), discontinuation (permanent [≥91 days with no restart] or temporary [≥91 days with subsequent restart]), switch, and augmentation (Cohort 1 only). Exploratory analysis of Cohort 1 explored potential drivers of treatment initiation.ResultsOverall, 5,065 patients initiated LABD-based therapy (Cohort 1), and 501 escalated to triple therapy (Cohort 2). In Cohort 1, 7.0% of patients were continuous users, 46.5% discontinued permanently, 28.5% discontinued temporarily, 2.8% augmented (added LAMA and/or LABA and/or ICS), and 15.2% switched therapy. In Cohort 2, 18.2% of patients were continuous users, 7.2% discontinued permanently, 27.9% discontinued temporarily, and 46.7% switched therapy. Exploratory analyses showed that time since COPD diagnosis was first recorded, pre-index exacerbation events, and concomitant medical conditions were potential drivers of initial maintenance treatment choices.ConclusionDiscontinuation among new initiators of LABD-based therapy was high in France, whereas few switched or augmented treatment. In comparison, permanent discontinuation within 18 months was low in patients escalating to triple therapy.

show abstract

Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners

Meeraus

Wood

Jakubanis

et al. 2018

COPD

View full text Add to dashboard Cite

show abstract

“…For example, a subset of patients with COPD demonstrate increased eosinophilic airway inflammation during exacerbations 19. Furthermore, peripheral blood eosinophil counts of ≥150 cells/µL have been shown to be associated with an increased risk of AECOPDs 19–21. Importantly, patients with increased blood eosinophil counts have a greater probability of benefit from treatment with ICS13,22–24 and treatments that specifically target eosinophilic inflammation 25…”

Section: Introductionmentioning

confidence: 99%

<p>Clinical burden of illness among patients with severe eosinophilic COPD</p>

Müllerová¹,

Meeraus²,

Galkin³

et al. 2019

COPD

View full text Add to dashboard Cite

Background: There are currently limited real-world data on the clinical burden of illness in patients with COPD who continue to exacerbate despite receiving triple therapy. The aim of this study was to compare the burden of COPD in patients with and without a phenotype characterized by a high blood eosinophil count and high risk of exacerbations while receiving triple therapy. Methods: This retrospective cohort study (GSK ID: 207323/PRJ2647) used UK Clinical Practice Research Datalink records linked with Hospital Episode Statistics. Eligible patients had a COPD medical diagnosis code recorded between January 1, 2004 and December 31, 2014, and a blood eosinophil count recorded on/after that date. Patients were followed from index date (first qualifying blood eosinophil count) until December 31, 2015. The study phenotype was defined as ≥2 moderate/≥1 severe acute exacerbation of COPD (AECOPD) in the year prior to the index date, current use of multiple-inhaler triple therapy (MITT), and blood eosinophil count ≥150 cells/µL on the index date. Outcomes measured during follow-up included moderate/severe AECOPDs, severe AECOPDs, all-cause mortality, primary care (GP) clinical consultations, and non-AECOPD-related unscheduled hospitalizations. Results: Of 46,814 patients eligible for inclusion, 2512 (5.4%) met the definition of the study phenotype. Adjusted rate ratios (95% CI) of moderate/severe AECOPDs and all-cause mortality in patients with the study phenotype versus those without were 2.32 (2.22, 2.43) and 1.26 (1.16, 1.37), respectively. For GP visits and non-AECOPD-related unscheduled hospitalizations, adjusted rate ratios (95% CI), in patients with the study phenotype versus those without, were 1.09 (1.05, 1.12) and 1.31 (1.18, 1.46), respectively. Conclusion: Patients with COPD and raised blood eosinophil counts who continue to exacerbate despite MITT represent a distinct subgroup who experience substantial clinical burden and account for high healthcare expenditure. There is a need for more effective management and therapeutic options for these patients.

show abstract

“…In this respect, a recent study showed that COPD exacerbations were the most significant factor for escalation 17. In another study,18 results showed that exacerbations had only a minor influence on treatment augmentation and that it was driven more by the need for rescue medication and assessment of dyspnea. In our study of patients with COPD experiencing an exacerbation event, it can be considered that exacerbations were the driver of MITT initiation and, in these cases, initiation sooner after the exacerbation had beneficial effects versus later MITT initiation.…”

Section: Discussionmentioning

confidence: 99%

<p>Economic impact of delaying initiation with multiple-inhaler maintenance triple therapy in Spanish patients with chronic obstructive pulmonary disease</p>

Mainar¹,

Huerta²,

Artieda³

et al. 2019

COPD

View full text Add to dashboard Cite

PurposeGuidelines recommend the use of triple therapy with an inhaled corticosteroid (ICS), a long-acting β2 agonist (LABA) and a long-acting muscarinic antagonist (LAMA) to reduce the risk of future exacerbations in symptomatic COPD patients with a history of exacerbations. This study aimed to estimate COPD-related healthcare resource use and costs, and subsequent exacerbation rates, for patients initiating multiple-inhaler triple therapy (MITT) early (≤30 days) versus late (31–180 days) following an exacerbation, in a real-world clinical setting.Patients and methodsThis was an observational, longitudinal, retrospective study using electronic medical records from the Spanish database of the Red de Investigación en Servicios Sanitarios Foundation. Patients ≥40 years old with a confirmed COPD diagnosis who were newly prescribed MITT up to 180 days after an exacerbation between January 2013 and December 2015 were included. Patients were followed from the date of MITT initiation for up to 12 months to assess COPD-related health care resource use (routine and emergency visits, hospitalizations, pharmacologic treatment), exacerbation rate, and costs (€2017); these endpoints were compared between early versus late groups.ResultsThe study included 1280 patients who met selection criteria: mean age 73 years, 78% male, and 41% had severe/very severe lung function impairment. The proportion of patients initiating MITT early versus late was 61.6% versus 38.4%, respectively. There were no statistically significant differences in baseline characteristics between groups. During follow-up, health care resource consumption was lower in the early versus late group, especially primary care and ED visits, leading to lower total costs (€1861 versus €1935; P<0.05). In the follow-up period, 28.0% of the patients in the early group experienced ≥1 exacerbation versus 36.4% in the late group (P=0.002), with an exacerbation rate of 0.5 versus 0.6 per person per year (P=0.022), respectively.ConclusionInitiating MITT early (≤30 days after an exacerbation) may reduce health care costs and exacerbation rate compared with late MITT initiation.

show abstract

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

Cited by 12 publications

References 19 publications

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners

<p>Clinical burden of illness among patients with severe eosinophilic COPD</p>

<p>Economic impact of delaying initiation with multiple-inhaler maintenance triple therapy in Spanish patients with chronic obstructive pulmonary disease</p>

Contact Info

Product

Resources

About