Impact of multiple-dose versus single-dose inhaler devices on COPD patients’ persistence with long-acting β2-agonists: a dispensing database analysis

Abstract

Background:With a growing availability of different devices and types of medication, additional evidence is required to assist clinicians in prescribing the optimal medication in relation to chronic obstructive pulmonary disease (COPD) patients’ persistence with long-acting β2-agonists (LABAs).Aims:To assess the impact of the type of inhaler device (multiple-dose versus single-dose inhalers) on 1-year persistence and switching patterns with LABAs.Methods:A retrospective observational cohort study was performed comparing a cohort of patients initiating multiple-dose inhalers and a cohort initiating single-dose inhalers. The study population consisted of long-acting bronchodilator naive COPD patients, initiating inhalation therapy with mono-LABAs (formoterol, indacaterol or salmeterol). Analyses were performed using pharmacy dispensing data from 1994 to 2012, obtained from the IADB.nl database. Study outcomes were 1-year persistence and switching patterns. Results were adjusted for initial prescriber, initial medication, dosing regimen and relevant comorbidities.Results:In all, 575 patients initiating LABAs were included in the final study cohort. Among them, 475 (83%) initiated a multiple-dose inhaler and 100 (17%) a single-dose inhaler. Further, 269 (47%) initiated formoterol, 9 (2%) indacaterol and 297 (52%) salmeterol. There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76–1.26, P=0.99). Over 80% re-started or switched medication.Conclusions:There seems no impact of inhaler device (multiple-dose versus single-dose inhalers) on COPD patients’ persistence with LABAs. Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year.

Primary non-adherence to inhaled medications measured with e-prescription data from Poland

“…In 2014 van Boven et al used a Dutch pharmacy dispensing data from 1994 to 2012 in order to analyse LABA persistence in COPD patients. The authors of that study found no significant differences between MDIs and DPIs [30]. We believe the differences observed in our study might be a result of generally lower out-of-pocket costs of MDIs, as compared to DPIs.…”

Primary non-adherence to inhaled medications measured with e-prescription data from Poland

“…In 2014 van Boven et al used a Dutch pharmacy dispensing data from 1994 to 2012 in order to analyse LABA persistence in COPD patients. The authors of that study found no signi cant differences between MDIs and DPIs (30). We believe the differences observed in our study might be a result of generally lower out-of-pocket cost of MDIs, as compared to DPIs.…”

Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study

“…Furthermore, we excluded patients who met the following exclusion criteria: (1) Receipt of another antibiotic treatment than doxycycline 3 days before till 7 days after the index date. (2) Age under 55 years, to reduce the chance of including possible asthma patients 30 31. Age was calculated using the difference between index date and birth date.…”

“…The following covariates were included as potential confounders: age; gender; frequently used maintenance drugs for COPD treatment within 365 days before index date including SABA, SAMA (short-acting muscarinic antagonist), LABA (ong-acting β agonist), LAMA (long-acting muscarinic antagonist), SABA/SAMA, LABA/LAMA, LABA/ICS (inhaled corticosteroid) and theophylline. Comorbidities in COPD patients were defined on the basis of at least two prescriptions of related drugs within 365 days prior to index date: diabetes (A10), heart failure (C01AA05 or C03C), ischaemic heart disease (C01DA), other cardiovascular disease (C02 or C03 or C07 or C08 or C09, but not for C01AA05, C03C and C01DA), dyslipidaemia (C10), osteoporosis (M05B), anxiety (N05B, N05C), dementia (N06D), depression (N06A), rheumatic arthritis (M01 or M02) and hypothyroid disease (H03) 30…”