Pharmacological treatment optimisation for stable COPD: an endless story?

Zysman, M.; Chabot, F.; Housset, B.; Panzini, Capucine Morélot; Devillier, Philippe; Roche, Nicolás

doi:10.1183/13993003.01250-2017

Cited by 8 publications

(9 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has been further hampered by the increasing complexity of COPD phenotypes and algorithms that are difficult to follow in busy outpatient settings. The need for context-specific implementation and tailoring guidelines according to local needs have been increasingly recognized and resulted in several national guidelines and position statements in the last years including Russian,8 Spanish,9 Czech,10 Saudi Arabian,11 Canadian,12 and French 13. In this paper, we present recommendations for treatment of COPD in Serbia.…”

Section: Introductionmentioning

confidence: 99%

<p>Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement</p>

Vukoja¹,

Kopitović²,

Lazić³

et al. 2019

COPD

View full text Add to dashboard Cite

In recent years, several national chronic obstructive pulmonary disease (COPD) guidelines have been issued. In Serbia, the burden of COPD is high and most of the patients are diagnosed at late stages. Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is poorly implemented in real-life practice, as many patients are still prescribed inhaled corticosteroids (ICS)-containing regimens and slow-release theophylline. In this document, we propose an algorithm for treating COPD patients in Serbia based on national experts’ opinion, taking into account global recommendations and recent findings from clinical trials that are tailored according to local needs. We identified four major components of COPD treatment based on country specifics: active case finding and early diagnosis in high-risk population, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on patients' ability and preferences. With this approach we aim to facilitate implementation of the recommendation, initiate the treatment in early stages, improve cost-effectiveness, reduce possible side effects, and ensure efficient treatment.

show abstract

Section: Introductionmentioning

confidence: 99%

<p>Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement</p>

Vukoja¹,

Kopitović²,

Lazić³

et al. 2019

COPD

View full text Add to dashboard Cite

show abstract

“…Over half of the patients who initiated triple therapy had at least one severe or two moderate exacerbations (55%) and most were stepped up from dual therapy for COPD (84%) thus indicating a good level of compliance with the French and international guidelines 4–6…”

Section: Discussionmentioning

confidence: 99%

“…However, we cannot rule out whether discontinuation may reflect a desire to step down treatment. Stepping down of triple therapy, usually via the removal of ICS, may be beneficial for some patients given adverse reactions 4 6 40. However, this requires careful clinical consideration especially if patients are currently stable after previously suffering exacerbations 4 41–43.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacological management of COPD is aimed at improving symptoms and reducing the frequency of exacerbations 4. In France, current COPD guidelines recommend an incremental approach towards triple therapy, which is recommended for patients who remain symptomatic or suffer acute exacerbation while being treated with dual therapy5 6 and an initiation by a pulmonologist 5. Composed of long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) and inhaled corticosteroid (ICS), triple therapy was only available as a multiple inhaler triple therapy (MITT) prior to 2018, that is, via two or more inhalers.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use and persistence of single and multiple inhaler triple therapy prescribed for patients with COPD in France: a retrospective study on THIN database (OPTI study)

Deslee,

Fabry-Vendrand,

Poccardi

et al. 2023

BMJ Open Resp Res

View full text Add to dashboard Cite

IntroductionFrom 2018 single inhaler triple therapy (SITT) became available in France to treat moderate-to-severe chronic obstructive pulmonary disease (COPD). Given its simplified inhaler use compared with multiple inhaler triple therapy (MITT), this therapeutic option has the potential to offer benefit in terms of improved persistence and adherence. Given the lack of real-world evidence of the effectiveness of triple therapy, this study was designed to evaluate the use of MITT and SITT in France and compare persistence.MethodsA retrospective cohort study was performed. Patients with COPD who initiated triple therapy between 1 July 2017 and 31 December 2019 were included from The Health Improvement Network, a large electronic medical database in France, which includes pharmacy data. A 60-day treatment gap defined discontinuation and thereby persistence.ResultsA total of 3134 patients initiated triple therapy for COPD in the study period, among them 485 with SITT. In 2019, the rate of use of SITT was 28.2%. The mean age (67.3 years) and sex (44.2% female) of patients initiating triple therapy was similar between MITT and SITT, and most patients had escalated from dual therapy (84.1%). However, SITT was more frequently initiated by a pulmonologist (59.8%) and a higher prevalence of comorbid asthma was observed for SITT (47.0% vs 37.9%). Persistence was assessed among patients who did not discontinue after a single dispensation of triple therapy (n=1674). Median persistence was 181 days for SITT and 135 days for MITT, and the covariate-adjusted HR for persistence was 1.47 (p<0.001) and the estimated persistence at 1 year was 33% for SITT compared with 18% for MITT.DiscussionThis study suggests that persistence was higher for the patients treated with SITT compared with MITT in France. Moreover, most patients initiated with triple therapy were previously treated with dual therapy and had exacerbations in the previous year.

show abstract

“…Several complementary and robust statistical models were used to expand simple multiple logistic regression for identifying factors explaining treatment choices. Results demonstrated that symptoms and respiratory function are clearly associated with escalating combinations of inhaled treatment but that the strength of associations remains relatively low despite clear French-language and global international recommendations [1, 21].…”

Section: Discussionmentioning

confidence: 99%

Are there specific clinical characteristics associated with physician’s treatment choices in COPD?

Roche¹,

Antoniadis²,

Hess³

et al. 2019

Respir Res

Self Cite

View full text Add to dashboard Cite

Background The number of pharmacological agents and guidelines available for COPD has increased markedly but guidelines remain poorly followed. Understanding underlying clinical reasoning is challenging and could be informed by clinical characteristics associated with treatment prescriptions. Methods To determine whether COPD treatment choices by respiratory physicians correspond to specific patients’ features, this study was performed in 1171 patients who had complete treatment and clinical characterisation data. Multiple statistical models were applied to explain five treatment categories: A: no COPD treatment or short-acting bronchodilator(s) only; B: one long-acting bronchodilator (beta2 agonist, LABA or anticholinergic agent, LAMA); C: LABA+LAMA; D: a LABA or LAMA + inhaled corticosteroid (ICS); E: triple therapy (LABA+LAMA+ICS). Results Mean FEV1 was 60% predicted. Triple therapy was prescribed to 32.9% (treatment category E) of patients and 29.8% received a combination of two treatments (treatment categories C or D); ICS-containing regimen were present for 44% of patients altogether. Single or dual bronchodilation were less frequently used (treatment categories B and C: 19% each). While lung function was associated with all treatment decisions, exacerbation history, scores of clinical impact and gender were associated with the prescription of > 1 maintenance treatment. Statistical models could predict treatment decisions with a < 35% error rate. Conclusion In COPD, contrary to what has been previously reported in some studies, treatment choices by respiratory physicians appear rather rational since they can be largely explained by the patients’ characteristics proposed to guide them in most recommendations. Electronic supplementary material The online version of this article (10.1186/s12931-019-1156-1) contains supplementary material, which is available to authorized users.

show abstract

Pharmacological treatment optimisation for stable COPD: an endless story?

Cited by 8 publications

References 27 publications

<p>Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement</p>

<p>Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement</p>

Use and persistence of single and multiple inhaler triple therapy prescribed for patients with COPD in France: a retrospective study on THIN database (OPTI study)

Are there specific clinical characteristics associated with physician’s treatment choices in COPD?

Contact Info

Product

Resources

About