&lt;p&gt;Prescribing Pathways to Triple Therapy: A Retrospective Observational Study of Adults with Chronic Obstructive Pulmonary Disease in the UK&lt;/p&gt;

Quint, Jennifer K; Venerus, Alessandra; O’Leary, Caroline; Myland, Melissa; Holmgren, Ulf; Varghese, Precil; Cabrera, Claudia

doi:10.2147/copd.s278101

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…Correspondingly, discontinuation of index treatment and escalation to triple therapy increased over the 2 years following index. Indeed, the median time to escalation to ICS/LAMA/LABA was approximately 3.3–4.0 years, similar to the 4-year estimate in a previous study of new users of dual therapy in the UK 20. These trends were similar in both the non-triple and the IMT user cohorts and across indexed therapies, indicating that these observations are not particular to any specific ICS/LABA therapy.…”

Section: Discussionsupporting

confidence: 80%

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

Czira,

Banks,

Requena

et al. 2024

BMJ Open

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ObjectiveManagement of chronic obstructive pulmonary disease (COPD) with inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) improves lung function and health status and reduces COPD exacerbation risk versus monotherapy. This study described treatment use, healthcare resource utilisation (HCRU), healthcare costs and outcomes following initiation of single-device ICS/LABA as initial maintenance therapy (IMT).DesignRetrospective cohort study.SettingPrimary care, England.Data sourcesLinked data from the Clinical Practice Research Datalink Aurum and Hospital Episode Statistics datasets.ParticipantsPatients with COPD and ≥1 single-device ICS/LABA prescription between July 2015 and December 2018 were included.Primary and secondary outcome measuresTreatment pathways, COPD-related HCRU and healthcare costs, COPD exacerbations, time to triple therapy, medication adherence (proportion of days covered ≥80%) and indexed treatment time to discontinuation. Data for patients without prior maintenance therapy history (IMT users) and non-triple users were assessed over a 12-month follow-up period.ResultsOf 13 451 new ICS/LABA users, 5162 were IMT users (budesonide/formoterol, n=1056; beclomethasone dipropionate/formoterol, n=2427; other ICS/LABA, n=1679), for whom at 3 and 12 months post-index, 45.6% and 39.4% were still receiving any ICS/LABA. At >6 to ≤12 months, the proportion of IMT users with ≥1 outpatient visit (10.1%) and proportion with ≥1 inpatient stay (12.6%) had increased from those at 3 months (9.0% and 7.4%, respectively). Inpatient stays contributed most to total COPD-related healthcare costs. For non-triple IMT users, at 3 and 12 months post-index, 4.5% and 13.7% had ≥1 moderate-to-severe COPD exacerbation. Time to triple therapy initiation and time to discontinuation of index medication ranged from 45.9 to 50.2 months and 2.3 to 2.8 months between treatments. Adherence was low across all time points (21.5–27.6%). Results were similar across indexed therapies.ConclusionsIn the year following treatment initiation, ICS/LABA adherence was poor and many patients discontinued or switched therapies, suggesting that more consideration and optimisation of treatment is required in England for patients initiating single-device ICS/LABA therapy.

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Section: Discussionsupporting

confidence: 80%

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

Czira,

Banks,

Requena

et al. 2024

BMJ Open

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“…This is not consistent with GOLD treatment guidelines for COPD, but similar trends have been observed in other retrospective studies of triple therapy treatment patterns in patients with COPD. For example, a similar study in various European countries and Australia by Quint et al 28 found that most patients were either receiving ICS+LABA (28.3%) or no previous therapy (22.7%) prior to triple therapy initiation, and another study in the United Kingdom by Quint et al 29 found that most patients were receiving either ICS+LABA (27.9%), LAMA (13.1%), or no previous therapy (12.1%) prior to triple therapy initiation. The study of patients initiating triple therapy in the United Kingdom also captured possible factors influencing pathways to triple therapy: female patients with severe COPD and comorbid asthma were more likely to have received previous therapy than no previous therapy prior to triple therapy initiation (compared with male patients and those without comorbid asthma and less severe COPD).…”

Section: Discussionmentioning

confidence: 93%

“…The study of patients initiating triple therapy in the United Kingdom also captured possible factors influencing pathways to triple therapy: female patients with severe COPD and comorbid asthma were more likely to have received previous therapy than no previous therapy prior to triple therapy initiation (compared with male patients and those without comorbid asthma and less severe COPD). 29 Although our analysis did not capture the reasons for MITT initiation, there are several possible explanations for why so many patients initiated MITT after receiving no previous therapy. Patients may have previously been prescribed treatment for COPD but discontinued its use as a result of no perceivable therapeutic benefits, or adverse side effects.…”

Section: Discussionmentioning

confidence: 99%

A Real-World Analysis of Treatment Patterns and Clinical Characteristics Among Patients with COPD Who Initiated Multiple-Inhaler Triple Therapy in New Zealand

Xu¹,

Miléa²,

Rojas³

et al. 2021

COPD

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Purpose Real-world data on maintenance treatment and prescription patterns provide insights into healthcare management among patients with chronic obstructive pulmonary disease (COPD), which benefits our understanding of current COPD treatment patterns in New Zealand. Methods We retrospectively analyzed real-world data from the HealthStat general practice database to evaluate treatment patterns among patients with COPD in New Zealand who initiated multiple-inhaler triple therapy (MITT): inhaled corticosteroid (ICS) + long-acting muscarinic antagonist + long-acting β 2 -agonist (LABA). Our main objective described treatment patterns (class, duration, modification, persistence, and adherence) and characteristics of patients with COPD initiating MITT between 1 May 2016 and 30 April 2017, with 12-months’ follow-up. We also assessed the number of patients receiving MITT between 2015 and 2017, among a larger patient population receiving long-acting bronchodilator and ICS-containing therapies. Results Of 6249 eligible patients, 421 (mean age 67.3 years; mean number exacerbations at baseline 1.8) initiated MITT: 59.1% received combination ICS/LABA therapy prior to MITT initiation, and median treatment duration prior to MITT initiation was 350 days. Overall, 33.5% of patients remained on index treatment for 12 months. Of the remaining patients who modified treatment (on average at 144.4 days), those who had a direct switch (24.9%) or retreatment (13.5%) remained on MITT, 19.7% of patients stepped down to mono/dual therapy, and 8.3% discontinued treatment. Mean (standard deviation) persistence to any MITT over 12 months was 47.3 (50.0), and 53.4% of patients were considered adherent to MITT. Total proportions of patients receiving long-acting bronchodilator therapy and MITT increased between 2015 and 2017. Conclusion Most patients with COPD in New Zealand who initiated MITT had characteristics appropriate for triple therapy prescription, suggesting prescription behavior among general practitioners was largely consistent with treatment guidelines. Our findings may help optimize treatment decisions, with a focus on improving long-term triple therapy persistence and adherence.

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“…Conversely, in a recent US study, which compared actual treatment choices according to COPD severity versus the GOLD recommendations, the authors identified gaps between actual use and guideline use and concluded that triple therapy was underutilized [ 23 ]. In another UK-based retrospective observational study of patients with COPD, treatment transitions leading to triple therapy in the UK were found to be diverse [ 24 ]. The major treatment transition leading to triple therapy was LABA/ICS, reported by 28% of patients [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…In another UK-based retrospective observational study of patients with COPD, treatment transitions leading to triple therapy in the UK were found to be diverse [ 24 ]. The major treatment transition leading to triple therapy was LABA/ICS, reported by 28% of patients [ 24 ]. In our study, 57% of treatment switches from LABA/ICS at 1MT were escalations to triple therapy, whereas escalation to triple therapy represented only 25% and 50% of switches from LAMA and LAMA/LABA, respectively.…”

Section: Discussionmentioning

confidence: 99%

Treatment Transitions in Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

et al. 2022

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Introduction: Previous studies have reported that more patients receive inhaled corticosteroid (ICS)-containing therapies than would be expected based on exacerbation history, suggesting overprescribing. We aimed to describe patterns of treatment switching from first (1MT) to second maintenance therapy (2MT) among COPD patients in the US and UK. Methods: We used healthcare data from the US IBM Ò MarketScan Ò and UK Clinical Practice Research Datalink databases (2015 -2018) to assess transitions between 1MT and 2MT among COPD patients. Patients with a recorded asthma diagnosis prior to 1MT were excluded. We assessed whether prescribed treatments (longacting muscarinic antagonists [LAMA], longacting b 2 -agonists [LABA], inhaled corticosteroids [ICS], as monotherapy or in combination) were consistent with global and national recommendations for COPD, identified patient characteristics associated with treatment transitions, and evaluated treatment duration. Results: Overall, 7028 patients in the US and 2461 in the UK initiated 2MT within a median (IQR) 160.0 (76.0; 335.0) and 218.0 (86.0; 428.0)days after 1MT, respectively. In the US, 33.6% of patients initiating 2MT had no recorded exacerbations in the previous year, whereas 23.1% had one and 43.3% had C 2. In the UK, 54.9% of patients had no recorded exacerbations in the previous year, whereas 20.9% had one and 24.2% had C 2. At 2MT, most patients switched to LAMA/LABA/ICS (26.1%) or LABA/ICS (25.8%) in the US, and LAMA/LABA (39.4%) or LAMA/LABA/ICS (27.8%) in the UK; 62.2% (US) and 47.5% of patients (UK) were prescribed ICScontaining regimens. The most common treatment transition from 1MT to 2MT was LABA/ ICS to LAMA/LABA/ICS (13.0%) in the US; and LAMA to LAMA/LABA (32.5%) and LAMA to LAMA/LABA/ICS (14.3%) in the UK. Conclusions: At 2MT, the proportion of patients on LAMA/LABA/ICS was similar between the US and UK, but treatment pathways were different.

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<p>Prescribing Pathways to Triple Therapy: A Retrospective Observational Study of Adults with Chronic Obstructive Pulmonary Disease in the UK</p>

Cited by 6 publications

References 20 publications

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

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

A Real-World Analysis of Treatment Patterns and Clinical Characteristics Among Patients with COPD Who Initiated Multiple-Inhaler Triple Therapy in New Zealand

Treatment Transitions in Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

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<p>Prescribing Pathways to Triple Therapy: A Retrospective Observational Study of Adults with Chronic Obstructive Pulmonary Disease in the UK</p>

Cited by 6 publications

References 20 publications

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

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

A Real-World Analysis of Treatment Patterns and Clinical Characteristics Among Patients with COPD Who Initiated Multiple-Inhaler Triple Therapy in New Zealand

Treatment Transitions in Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases

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Product

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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

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