Real-life use of long-acting antimuscarinic agents following their approval for COPD treatment

Roche, N.; Jébrak, G.; Caillaud, D.; Deslée, G.; Brinchault, Graziella; Chanez, Pascal; Court-Fortuné, Isabelle; Escamilla, R.; Nesme-Meyer, Pascale; Pinet, C.; Carré, Philippe; Paillasseur, Jean-Louis; Pérez, Thierry; Burgel, Pierre‐Régis

doi:10.1183/09031936.00131614

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Similar to our results, the authors found that in 32.5% of cases, the new LAMA was added to LABA/ICS as triple therapy and very infrequently used as monotherapy 17. Also in the UK, the most frequent pathway to triple therapy was the addition of a LAMA to the existing treatment with a LABA/ICS 18.…”

Section: Discussionsupporting

confidence: 88%

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Monteagudo¹,

Roset²,

Rodríguez-Blanco³

et al. 2017

COPD

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ObjectiveTo describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia.DesignWe performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. A descriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts.ResultsA total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0–8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months.ConclusionPatients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy.

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Section: Discussionsupporting

confidence: 88%

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Monteagudo¹,

Roset²,

Rodríguez-Blanco³

et al. 2017

COPD

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“…However, review of these recommendations prompts the suggestion that simplification of diagnostic criteria, particularly for primary care physicians, could significantly enhance patient identification and initiation of care. This is an important issue since multiple studies from Europe have indicated that COPD is greatly underdiagnosed [ 1 , 26 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

A review of national guidelines for management of COPD in Europe

et al. 2016

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The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments.

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“…In recent years, a number of studies revealed a high degree of overtreatment with respiratory medication, in particular with inhaled corticosteroids (ICS), in patients with COPD and especially in GOLD groups A and B. [1][2][3][4][5] Despite the narrow indication for the prescription of ICS in COPD, their use has been reported in up to 70% of patients in some European countries, such as Switzerland, Greece, and the UK. [6][7][8] In line with this, data from the COSYCONET COPD cohort also showed that about 2/3 of patients received an inhaled corticosteroid, though this would have been indicated in only about 50% according to GOLD 2017 recommendations.…”

Section: Introductionmentioning

confidence: 99%

Treatment of COPD Groups GOLD A and B with Inhaled Corticosteroids in the COSYCONET Cohort – Determinants and Consequences

Lutter¹,

Jörres²,

Trudzinski³

et al. 2021

COPD

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Background In COPD patients of GOLD groups A and B, a high degree of treatment with inhaled corticosteroids (ICS) has been reported, which is regarded as overtreatment according to GOLD recommendations. We investigated which factors predict ICS use and which relationship it has to clinical and functional outcomes, or healthcare costs. Methods We used pooled data from visits 1 and 3 of the COSYCONET cohort (n=2741, n=2053, interval 1.5 years) including patients categorized as GOLD grades 1–4 and GOLD group A or B at both visits (n=1080). Comparisons were performed using ANOVA, and regression analyses using propensity matching and inverse probability weighting to adjust for differences between ICS groups. These were defined as having ICS at both visits (always) vs no ICS at both visits (never). Measures were divided into predictors of ICS treatment and outcomes. Results Among 1080 patients, 608 patients were eligible for ICS groups (n=297 never, n=311 always). Prior to matching, patients with ICS showed significantly (p<0.05 each) impaired lung function, symptoms and exacerbation history. After matching, the outcomes generic quality of life and CO diffusing capacity were increased in ICS patients (p<0.05 each). Moreover, costs for respiratory medication, but not total health care costs, were significantly elevated in the ICS group by 780€ per year. Conclusion ICS therapy in COPD GOLD A/B patients can have small positive and negative effects on clinical outcomes and health care costs, indicating that the clinical evaluation of ICS over-therapy in COPD requires a multi-dimensional approach.

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Real-life use of long-acting antimuscarinic agents following their approval for COPD treatment

Cited by 3 publications

References 13 publications

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

Characteristics of COPD patients initiating treatment with aclidinium or tiotropium in primary care in Catalonia: a population-based study

A review of national guidelines for management of COPD in Europe

Treatment of COPD Groups GOLD A and B with Inhaled Corticosteroids in the COSYCONET Cohort – Determinants and Consequences

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