Real-world outcomes in patients with chronic obstructive pulmonary disease initiating long-acting mono bronchodilator therapy

Abstract

Background:Randomized clinical trials have shown long-acting mono bronchodilator therapy to be efficacious in improving lung function and dyspnea, while reducing exacerbations; however, less is known regarding the effectiveness in routine clinical practice. This study examined treatment patterns, rescue medication use, healthcare resource utilization and costs, and exacerbations in patients with chronic obstructive pulmonary disease (COPD) who initiated long-acting mono bronchodilator therapy in real-world settings.Methods:This retrospective study used US claims data from adult patients with COPD initiating long-acting mono bronchodilator therapy between 1 January 2008 and 31 January 2015. Patients were required to have continuous health plan enrollment 12 months prior to (baseline period) and 12 months following therapy initiation (follow-up period). Outcomes, including treatment patterns, rescue medication use, exacerbations, and healthcare utilization and costs, were measured until the earliest of treatment augmentation or discontinuation, death, health plan disenrollment, or the end of the study period. Results were analyzed descriptively for all measures. Baseline and follow-up measures of all-cause and COPD-related healthcare costs and exacerbations [per patient per month (PPPM)] were compared using paired t tests.Results:Among 27,394 patients with a mean follow up of 6.3 months, 18.2% augmented, 74.2% discontinued, and 7.6% continued long-acting mono bronchodilator therapy. Rescue medication use was prevalent during the follow-up period, with an average of 1.0 short-acting β agonist (SABA) fills/month and 0.8 short-acting muscarinic antagonist (SAMA) fills/month, among patients with at least one fill for the medication of interest. PPPM mean number of exacerbations was more than triple (0.17 versus 0.05, p < 0.001) and PPPM exacerbation-related costs were more than double over the follow-up period compared with baseline ($1070 versus $485). COPD-related costs accounted for 50% of all-cause costs during the follow-up period and were significantly higher compared with baseline ($1206 versus $592, p < 0.001).Conclusions:Patients initiating long-acting mono bronchodilator therapy had high rates of medication discontinuation or augmentation. Patients used more rescue medications and experienced significantly more COPD exacerbations with higher healthcare costs compared with baseline. Further research is warranted to determine whether more aggressive initial therapy would result in symptom improvement.

<p>Association Between Adherence to Maintenance Medication in Patients with COPD and Acute Exacerbation Occurrence and Cost in China: A Retrospective Cohort Database Study</p>

“…A study based on insurance claims in the USA showed that patients who started long-term bronchodilator monotherapy showed high rates of treatment discontinuation or augmentation, as well as high rates of use of rescue therapy, and high treatment costs. 23 Another realworld study from the USA showed that patients starting a LAMA/LABA combination had higher adherence than patients starting an ICS/LABA combination. 24 Two studies from the United Kingdom revealed that the rate of prescribing according to the guidelines was low and that many patients were over-treated, and with poor adherence to treatment.…”

Changes in medication adherence among patients with asthma and COPD during the COVID-19 pandemic

“…1 The recommended use of daily controller therapy for asthma and chronic obstructive pulmonary disease (COPD) has been associated with improved disease outcomes and decreased risk of respiratory exacerbations. [1][2][3] Increased adherence to daily medications is multifactorial and during the present pandemic may be driven by a patient's concern of his or her respiratory symptoms being associated or confused with COVID-19. Patients with well-managed symptoms are also less likely to seek acute respiratory care at health care facilities and emergency departments, which decreases the risk of incidental exposure to SARS-CoV-2 and allows health care providers to focus attention on patients with other critical needs.…”

Impact of the COVID-19 pandemic on asthma control among children: a qualitative study from caregivers’ perspectives and experiences

“…Our study also found that asthma control in children who closely followed daily medication regimens before the epidemic and reserved controller medication in advance was less affected by the epidemic. This finding reminds us that children with asthma should adhere to daily medication therapy at the ordinary times, especially during the COVID-19 outbreak, which can decrease the risk of respiratory exacerbations and improve asthma outcomes, [37][38][39] and that they should reserve medicines in advance according to doctors' prescriptions to cope with the challenges of COVID-19.…”