Treatment Evolution after COPD Diagnosis in the UK Primary Care Setting

Abstract

RationaleTo assess the treatment progression during the 24 months following a formal diagnosis of chronic obstructive pulmonary disease (COPD) in the UK primary care setting.MethodsA retrospective cohort of newly diagnosed COPD patients was identified in the Clinical Practice Research Datalink (CPRD) from 1/1/2008 until 31/12/2009. Maintenance therapy prescribed within the first 3 months of diagnosis and in the subsequent 3-month intervals for 24 months were analyzed. Treatment classes included long-acting β2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids (ICSs), and respective combinations. At each 3-month interval, discontinuation, switching, addition, and stepping down patterns were analyzed cumulatively for the first 12 months and over the 24-month of follow-up.ResultsA total of 3199 patients with at least one prescription of a maintenance therapy at baseline and during 4th-6th month interval were included in the analysis. At diagnosis (0–3 months), the most frequently prescribed maintenance therapy was LABA+ICS (43%), followed by LAMA (24%) and LABA+LAMA+ICS (23%). Nearly half the patients (LABA-50%, LAMA-43%) starting on a monobronchodilator had additions to their treatment in 24 months. Compared to other medications, patients starting on a LAMA were most likely to escalate to triple therapy in 24 months. Nearly one-fourth of the patients prescribed triple therapy at baseline stepped down to LABA+ICS (25%) or LAMA (31%) within 24 months.ConclusionDisease progression is evident over the 24 months after COPD diagnosis, as more patients were prescribed additional maintenance therapy in the 24-month period compared to baseline. The changes in therapy suggest that it is difficult to achieve a consistently improved COPD disease state.

The burden of chronic obstructive pulmonary disease associated with maintenance monotherapy in the UK

“…In our study, it was observed that within 2 years of initiating treatment for COPD, ICS therapy was added to 43% of patients on LABA or LAMA monotherapy, despite the low rate of exacerbations. This may reflect inappropriate initiation of ICS as previously described and is in line with the findings from other studies 16,17…”

FULFIL Trial: Once-Daily Triple Therapy for Patients with Chronic Obstructive Pulmonary Disease

“…The use of inhaled triple pharmacologic therapy by patients with chronic obstructive pulmonary disease (COPD) is common; a UK study found that after 2 years, 46% of patients initially prescribed a long-acting bronchodilator and 39% of those prescribed an inhaled corticosteroid (ICS)/long-acting β 2 -agonist (LABA) or ICS plus long-acting muscarinic antagonist (LAMA) progressed to triple therapy (1). In a US study, 25.5% of patients with COPD, who had received at least one LAMA, LABA, ICS, or phosphodiesterase-4 inhibitor, received triple therapy within 2 years of being diagnosed (2) 4 advanced, symptomatic COPD, who are at risk of exacerbations.…”

Progress and Prospects for Long-Acting Β 2 -Agonists in the Treatment of Chronic Obstructive Pulmonary Disease

“…Программа Adelphi, ориенти-рованная на респираторные заболевания, пред-ставлявшая собой перекрестное исследование консультирования пациентов в странах Европы и в США, показала конфликт между текущей реальной практикой и рекомендациями глобальной инициа-тивы GOLD в редакции 2011 г., документируя тот факт, что значительная часть больных с низким риском продолжают получать ИГКС/ДДБА как от-дельно, так и в сочетании с ДДАХ [68]. Более того, ДДБА как монотерапию получал небольшой процент больных с ХОБЛ из групп А и В. Было показано, что в реальной жизни переключение с ДДАХ на ДДБА, а также шаг вниз от ИГКС/ДДБА к ДДБА или ДДАХ встречались нечасто [69], в этой связи интересно понять прогрессивное снижение интереса к разра-ботке новых ультра-ДДБА в качестве монотерапии.…”