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Abstract
Purpose
Long-acting bronchodilator (LABD) use is the mainstay of pharmacologic treatment for chronic obstructive pulmonary disease (COPD). Few studies describe evolving patterns of LABD use in the setting of changing inhaler availability and updated clinical guidelines.
Methods
A retrospective cohort study in New Zealand using the HealthStat general practice database (01/2014 to 04/2018). Eligible patients (aged ≥40 years) had COPD and ≥1 LABD prescription (long-acting muscarinic antagonist [LAMA] and/or long-acting β2-agonist [LABA]) during the index period (05/2015 to 04/2016). Demographics and clinical characteristics of all LABD users (overall/by treatment) were described at baseline. Patients starting LABD treatment during the index period, termed “new” users, were also described, as was their treatment evolution over 24 months of follow-up. Yearly LABD initiation rates were assessed from 2015 to 2017, covering changes to Pharmaceutical Management Agency criteria and clinical guidelines.
Results
Across 2140 eligible patients, the most common index treatments were inhaled corticosteroid (ICS)/LABA (59.0%) and open triple therapy (LAMA+LABA+ICS; 26.7%). ICS/LABA therapy was highest in younger patients, with open triple therapy highest in older patients. Prior yearly exacerbation rates were lowest in those receiving monotherapy (LABA: 0.9/year; LAMA: 1.1/year) versus dual therapy (all 1.4/year) and open triple therapy (2.2/year). Of 312 new LABD users, ICS/LABA was the most common index treatment (69.6%), followed by LAMA monotherapy (16.0%). Continuous use with index treatment was 31.1% at 12 months and 13.5% at 24 months; mean time to treatment change was 175.5 and 244.1 days, respectively. Among patients modifying treatment at 24 months, 23.0% augmented, 7.0% switched, 45.6% re-started, and 24.4% discontinued/stepped down. Among patients initiating LABD each year from 2015 to 2017, LAMA prescription increased (17% to 46%) while ICS prescription remained stable (approximately 20%).
Conclusion
Predominant use of ICS/LABA (05/2015 to 04/2016) reflects available LABDs and previous restrictions on LAMA use in New Zealand.
Data Sharing Statement
Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com.
Acknowledgments
Medical writing support for the development of this manuscript (in the form of manuscript development, collating author comments, and grammatical editing), under the direction of the authors, was provided by Joanna Wilson, PhD, of Ashfield MedComms (Glasgow, UK), an Ashfield Health company, and was funded by GlaxoSmithKline plc. Trademarks are owned by or licensed to their respective owners.
Author Contributions
All authors made a significant contribution to the work reported (whether in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas); took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
DM, AANR, SS, and BM are employees of, and shareholders in, GlaxoSmithKline plc. S-HY and JB are former employees of GlaxoSmithKline plc. YN is a former employee of Adelphi Real World, who received funding from GlaxoSmithKline plc. to conduct this study. RPY and RJS have received honorarium from GlaxoSmithKline plc. for educational talks and participation in advisory groups. BG is an employee of CBG Health Research Ltd, who received funding from GlaxoSmithKline plc. to conduct this study. The authors report no other conflicts of interest in this work.