Characterisation of patients with chronic obstructive pulmonary disease initiating single-device inhaled corticosteroids/long-acting β₂-agonist dual therapy in a primary care setting in England

Abstract

IntroductionTreatment pathways of patients with chronic obstructive pulmonary disease (COPD) receiving single-device dual therapies in England remain unclear. This study describes the characteristics of patients with COPD before initiating treatment with a single-device inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) in primary care in England.MethodsThis is a retrospective, descriptive study of linked primary and secondary healthcare data (Clinical Practice Research Datalink Aurum, Hospital Episode Statistics). Patients with COPD were indexed on first prescription of fixed-dose, single-device ICS/LABA (June 2015–December 2018). Demographics, clinical characteristics, prescribed treatments, healthcare resource use (HCRU) and direct healthcare costs were assessed over 12 months pre-index. Incident users (indexed on first ever prescription) could be non-triple users (no concomitant long-acting muscarinic antagonist at index); a subset were initial maintenance therapy (IMT) users (no history of pre-index maintenance therapy).ResultsOverall, 13 451 incident users (non-triple users: 7448, 55.4%; IMT users: 5162, 38.4%) were indexed on beclomethasone dipropionate/formoterol (6122, 45.5%), budesonide/formoterol (2703, 20.1%) or Other ICS/LABA combinations (4626, 34.4%). Overall, 20.8% of incident users had comorbid asthma and 42.6% had ≥1 moderate-to-severe acute exacerbation of COPD pre-index. Baseline characteristics were similar across indexed therapies. At 3 months pre-index, 45.3% and 35.4% of non-triple and IMT users were receiving maintenance treatment. HCRU and direct healthcare costs were similar across indexed treatments. Prescribing patterns varied regionally.ConclusionPatient characteristics, prior treatments, prior COPD-related HCRU and direct healthcare costs were similar across single-device ICS/LABAs in primary care in England. A high proportion of patients were not receiving any respiratory medication pre-index, indicating that prescribing in primary care in England is more closely aligned with national guidelines than global treatment strategies. Comorbid asthma may have influenced prescribing decisions. Less than half of users had preindex exacerbations, suggesting that ICS/LABA is not being prescribed principally based on exacerbation history.

Combined therapy of broncho-obstructive pathology: two solutions to one problem

“…В рамках первичной медико-санитарной помощи в Англии при анализе лечения 13 451 пациента с ХОБЛ беклометазона дипропионат/формотерол получали 45,5%, будесонид/формотерол -20,1%, другие комбинации ИГКС/ДДБА -34,4%. Авторы отметили, что назначение в первичной медико-санитарной помощи Англии более тесно связано с национальными рекомендациями, чем с глобальными стратегиями лечения [18].…”

Treatment pathways, economic burden and clinical outcomes in new users of inhaled corticosteroid/long-acting B2-agonist dual therapy with chronic obstructive pulmonary disease in a primary care setting in England: a retrospective cohort study

“…Additionally, it is of clinical interest to understand the real-world experience with regard to adherence to treatment and the economic burden of COPD in patients on ICS/LABA therapy. The patient demographics, clinical characteristics, prescribed treatments, HCRU and costs in the year prior to initiation of single-device ICS/LABA dual therapy in a real-world general practice cohort of patients with COPD in England have been previously described 13. This study subsequently investigated prescribed treatments, HCRU, direct healthcare costs and clinical outcomes following initiation of this single-device ICS/LABA dual therapy.…”