Prescribing Pathways to Triple Therapy: A Multi-Country, Retrospective Observational Study of Adult Patients with Chronic Obstructive Pulmonary Disease

Abstract

Introduction: Maintenance treatment strategies in COPD recommend inhaled corticosteroid (ICS) ? long-acting muscarinic antagonist (LAMA) ? long-acting b 2-agonist (LABA) triple therapy after initial dual therapy. Little is known about how treatment pathways to triple therapy vary across countries in clinical practice. Methods: This multi-country, retrospective cohort study (conducted 1 January 2005-1 May 2016) included patients with a COPD diagnosis, and (UK only) evidence of smoking history, or (France, Italy, Germany, and Australia) an indicator confirming COPD diagnosis, a first instance of triple therapy recorded during the study period and C 12 months of data prior to this date. Treatment pathways to triple therapy were analyzed in patients whose first instance of triple therapy was on or after the initial COPD diagnosis. The proportion of patients who initiated triple therapy prior to initial COPD diagnosis was also estimated. Meta-analyses of the main results were performed. Results: In 130,729 patients across all countries, mean age (standard deviation) ranged from 63.4 (10.4) years (Germany) to 69.8 (9.9) years (Italy), and median time (interquartile range) from initial COPD diagnosis to first prescription of triple therapy ranged from 16.9 (5.7-36.2) months (Australia) to 42.5 (13.9-87.4) months (UK). ICS ? LABA was the most common treatment pathway prior to triple therapy in the UK, Germany, and Italy (27.3%-31.6%); no previous maintenance therapy prior to triple therapy was the most common pathway in France and Australia (32.5% and 37.9%, respectively). Meta-analyses provided a pooled estimate of 20.4% (95% confidence interval: 13.8%-29.1%) for the proportion of patients initiating triple therapy at or before initial COPD diagnosis. Conclusions: In this retrospective cohort study, treatment pathways to triple therapy were

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

“…Given that this study is unique among studies of COPD in New Zealand, and that there is variation between similar studies of triple therapy treatment patterns in other countries, it cannot be said whether our findings reflect expected treatment patterns of patients initiating MITT. For example, the study in Europe and Australia by Quint et al 28 found that, overall, patients had longer median times to treatment modification than in our study (ranging from 2.7–18.2 months), but that the proportions of patients stepping down from or discontinuing MITT were much higher (ranging from 59.1%–84.9%). Another study in the United States by Bogart et al 34 found that, when allowing for 30 days after the last day of treatment, patients had a median time to treatment discontinuation of 1.8 months and 86% of MITT users discontinued their treatment in 12 months’ follow-up.…”

“…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).…”

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

“…Following the publication of a multi-country, retrospective database study that provided insights into global prescribing pathways to triple therapy, 14 this study focused solely on the prescribing pathways in UK clinical practice. The median time from diagnosis to initiation of triple therapy was approximately 3.5 years (42.5 months), which is comparable to findings of an earlier UK primary care database study by Brusselle et al, which found more than 50% of patients to have started triple therapy within 3 years.…”

“…[11][12][13] For example, an earlier analysis of prescribing patterns in the UK found that triple therapy was initiated as the first therapy following diagnosis in 10% of patients with COPD. 13 Following the publication of a multicountry, retrospective database study examining prescribing pathways to triple therapy, 14 our study aimed to explore the current treatment pathways to triple therapy specifically in the UK.…”

Beyond Dual Bronchodilation – Triple Therapy, When and Why

“… 11 However, the transition to triple therapy in those already on regular treatment for COPD, which is not necessarily a LABA/LAMA combination, follows pathways that are influenced by many different factors that vary both within and between countries probably due to differences in prescribing practices. 12 …”