Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: a real-world study

Abstract

Prescribing patterns in chronic obstructive pulmonary disease (COPD) are often inconsistent with published guidelines. This retrospective, observational study utilised data from the Optimum Patient Care Research Database to examine the changes in COPD prescribing patterns over time and to identify predictors of physician treatment choice for patients newly diagnosed with COPD. Initial therapy was defined as the treatment(s) prescribed at or within 1 year before COPD diagnosis. Changes over time were assessed in three cohorts based on the date of diagnosis: (1) 1997–2001; (2) 2002–2006; and (3) 2007–2010. Factors affecting the odds of being prescribed any initial therapy or any initial maintenance therapy were identified by univariable and multivariable logistic regression. The analysis included 20,154 patients, 45% of whom were prescribed an initial regimen containing an inhaled corticosteroid (ICS), whereas 28% received no initial pharmacological treatment. Prescribing of ICS monotherapy decreased over time, as did the proportion of patients receiving no therapy at or within 1 year before diagnosis. Comorbid asthma, a high exacerbation rate, increased symptoms and poor lung function each increased the likelihood of being prescribed any initial therapy or initial maintenance therapy; comorbid asthma and an annual rate of ⩾3 exacerbations were the strongest predictors. In conclusion, our analyses revealed major differences between actual prescribing behaviour and guideline recommendations for patients with newly diagnosed COPD, with many patients receiving no treatment and large numbers of patients receiving ICS-containing regimens. Predictors of initial therapy were identified.

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

“…Several other studies have reported undertreatment with bronchodilators in comparison with ICS [9,13], or a majority of patients receiving LABA/ICS without LAMA [16]. Rather few studies have investigated temporal change in treatment patterns, but our results of decreased proportions of patients with sole ICS treatment or no maintenance treatment at all over time are consistent with a study of COPD patients in UK primary care [12]. …”

Patterns of use of long‐acting bronchodilators in patients with COPD: A nationwide follow‐up study of new users in New Zealand

“…The overall finding of this study—that the prescribing of long‐acting bronchodilators and ICSs in patients with COPD does not appear to align with GOLD guidelines—is consistent with recent studies based on subgroups of patients in a variety of settings. Our observation that the most commonly dispensed first regimen involving a long‐acting bronchodilator was a LABA in combination with an ICS is consistent with findings from Spain, the Netherlands and some, but not all, studies based in the UK. In several studies, researchers have had access to detailed clinical information which enabled them to assess the appropriateness of ICS use and subsequently conclude that ICS therapy was being overused .…”

“…Recent studies in diverse settings have found that prescribing practice does not conform to international or national COPD treatment guidelines, or drug licencing conditions . However, these investigations have been based on subgroups of patients drawn from selected general practices, health insurance databases, or respiratory outpatient clinics or hospitals, and none have examined the longitudinal patterns of use of long‐acting bronchodilator therapy in new users across an entire country.…”

Use of large‐scale veterinary data for the investigation of antimicrobial prescribing practices in equine medicine

“…Prescribing behaviours in human medicine have been studied to detect over-and under-prescription, links with adverse effects, and to characterise suboptimal antimicrobial stewardship in this age of increasing bacterial antimicrobial resistance [1][2][3][4][5][6]. Interrogation of medical records datasets is expedited and validated thanks to widespread use of embedded standardised clinical terminologies (e.g.…”