Can Assessment of Disease Burden Prior to Changes in Initial COPD Maintenance Treatment Provide Insight into Remaining Unmet Needs? A Retrospective Database Study in UK Primary Care

Figures & data

Table 1. Patient demographics prior to long-acting bronchodilator initiation.

	LABA	LAMA	LABA/ICS	p
	(N = 1317)	(N = 6695)	(N = 9246)	for difference
Gender, male (%)	53	57	52	<0.0001
Age at index date, mean (SD)	68.6 (10.8)	69.3 (10.4)	68.4 (11.4)	<0.0001
Current smoker (%)^a	42	47	38	<0.0001
BMI, mean (SD)^b	27.8 (6.0)	27.2 (6.2)	27.7 (6.5)	0.0002
Dyspnoea (%)^a,c
MRC grade <3	59	55	57	0.1076
MRC grade ≥3	41	45	43
Moderate to severe COPD exacerbation (% with ≥1 event)^d	36	35	45	<0.0001
Discontinued maintenance treatment after first prescription, (%)^e	11	8	19	<0.0001

^a Value closest to index date in prior 12 months to 3 months after index date (12 months prior only for MRC grade).

^b Percentages represent distribution in patients with a known value. BMI data unknown for N = 378 (29%) LABA users, N = 1866 (28%) LAMA users and N = 3188 (34%) LABA/ICS users.

^c Percentages represent distribution in patients with a known value. Dyspnoea data unknown for N = 443 (34%) LABA users, N = 2356 (35%) LAMA users, and N = 4196 (45%) LABA/ICS users.

^d Exacerbations in prior 12 months before index date.

^e Patient did not have another prescription for COPD maintenance therapy of any kind after the index prescription through the 24 months of follow-up.

BMI, body mass index; COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; MRC, Medical Research Council dyspnoea scale 1–5; SD, standard deviation.

Figure 1. Treatment augmentation and switches within 24 months of initiation of a first maintenance COPD therapy with LABA, LAMA or ICS/LABA. Note: This analysis excluded 141 LABA initiators, 323 LAMA initiators and 1733 ICS/LABA initiators who did not receive any COPD maintenance therapy prescription either replacing initiation therapy or adding a different kind of therapy after their index prescription throughout the 24-month follow-up period. In total, 18% (N = 211) of LABA users switched therapy and 35% (N = 410) augmented therapy (patients could contribute multiple augmentations, and thus, the height of the bar is greater than 35%). In total, 6% (N = 383) of LAMA users switched therapy, 37% (N = 2306) augmented therapy (patients could contribute multiple augmentations, and thus, the height of the bar is greater than 37%). In total, 4% (N = 287) of LABA/ICS users switched therapy (only switches to LAMA were considered as a change to LABA alone or ICS alone was considered a discontinuation of LABA/ICS combination therapy), 36% (N = 2708) augmented to triple therapy. COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist.

Table 2. Disease burden and healthcare resource utilisation in the 30 days prior to a treatment modification amongst the LABA, LAMA and ICS/LABA cohorts.

	LABA (N = 1176)			LAMA (N = 6171)			ICS/LABA (N = 7513)
	Switched therapy N = 211	Addition resulting in dual therapy N = 410	Addition resulting in triple therapy N = 117	Switched therapy N= 383	Addition resulting in dual therapy N = 662	Addition resulting in triple therapy N = 1819	Switched therapy N = 287	Stepped up to triple therapy N = 2708
Disease Burden
Moderate to severe COPD exacerbations, % with ≥ 1 event	12	15	24	15	11	18	8	15
Hospitalized (severe) COPD exacerbations, % with ≥ 1 event	4	3	5	5	4	4	2	5
Dyspnea, % with MRC value recorded	33	41	35	32	36	37	39	41
MRC grade ≥ 3 among those with recorded value, %	63	51	76	55	58	65	45	60
Airflow limitation, % with value recorded	15	16	14	11	15	15	16	17
FEV1 <50% predicted among those with recorded value, %	31	25	50	32	24	43	22	40
Other COPD Medication Use
SABD, % with ≥ 1 prescription	63	62	64	55	63	61	46	59
OCS, % with ≥ 1 prescription	13	16	27	18	16	22	11	18
Healthcare Resource Utilization
Non-COPD hospitalizations, % with ≥ 1 event	7	3	3	4	3	5	4	4
GP visits, % with ≥ 1 visit	90	94	93	88	91	92	86	90

Note: This analysis excluded 141 LABA initiators, 323 LAMA initiators, and 1733 ICS/LABA initiators who did not receive another COPD maintenance therapy prescription of any kind after their index prescription through the 24-month follow-up period.

COPD, chronic obstructive pulmonary disease; GP, general practitioner; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; MRC, Medical Research Council dyspnoea scale 1–5; OCS, oral corticosteroid; SABD, short-acting bronchodilator; SD, standard deviation.