A Real-World Analysis of Treatment Patterns and Clinical Characteristics Among Patients with COPD Who Initiated Multiple-Inhaler Triple Therapy in New Zealand

Abstract

Purpose

Real-world data on maintenance treatment and prescription patterns provide insights into healthcare management among patients with chronic obstructive pulmonary disease (COPD), which benefits our understanding of current COPD treatment patterns in New Zealand.

Methods

We retrospectively analyzed real-world data from the HealthStat general practice database to evaluate treatment patterns among patients with COPD in New Zealand who initiated multiple-inhaler triple therapy (MITT): inhaled corticosteroid (ICS) + long-acting muscarinic antagonist + long-acting β₂-agonist (LABA). Our main objective described treatment patterns (class, duration, modification, persistence, and adherence) and characteristics of patients with COPD initiating MITT between 1 May 2016 and 30 April 2017, with 12-months’ follow-up. We also assessed the number of patients receiving MITT between 2015 and 2017, among a larger patient population receiving long-acting bronchodilator and ICS-containing therapies.

Results

Of 6249 eligible patients, 421 (mean age 67.3 years; mean number exacerbations at baseline 1.8) initiated MITT: 59.1% received combination ICS/LABA therapy prior to MITT initiation, and median treatment duration prior to MITT initiation was 350 days. Overall, 33.5% of patients remained on index treatment for 12 months. Of the remaining patients who modified treatment (on average at 144.4 days), those who had a direct switch (24.9%) or retreatment (13.5%) remained on MITT, 19.7% of patients stepped down to mono/dual therapy, and 8.3% discontinued treatment. Mean (standard deviation) persistence to any MITT over 12 months was 47.3 (50.0), and 53.4% of patients were considered adherent to MITT. Total proportions of patients receiving long-acting bronchodilator therapy and MITT increased between 2015 and 2017.

Conclusion

Most patients with COPD in New Zealand who initiated MITT had characteristics appropriate for triple therapy prescription, suggesting prescription behavior among general practitioners was largely consistent with treatment guidelines. Our findings may help optimize treatment decisions, with a focus on improving long-term triple therapy persistence and adherence.

Keywords:

• chronic obstructive pulmonary disease
• inhaled corticosteroid
• long-acting β-agonist
• long-acting muscarinic antagonist
• New Zealand
• multiple-inhaler triple therapy

Data Sharing Statement

Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com.

Acknowledgments

The authors would like to thank Janine Beale (affiliated with GlaxoSmithKline plc., New Zealand at the time of the study) for her contributions to study setup until December 2019. Medical writing support for the development of this manuscript, 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.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

XX received funding from GlaxoSmithKline plc. (through GMP Technologies PTE Ltd.) to conduct this study. DM, AANR, AB, and BM are employees of, and shareholders in, GlaxoSmithKline plc. TH is an employee of Adelphi Real World, who received funding from GlaxoSmithKline plc. to conduct this study. RY and RJS have received honorarium from GlaxoSmithKline plc. for educational talks and participation in advisory groups. BG is an employee of, shareholder in, and receives funding for project management and analysis from CBG Health Research Ltd, and is also a shareholder in HealthStat who received funding for data collection from GlaxoSmithKline plc. to conduct this study. Trademarks are owned by or licensed to their respective owners. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was funded by GlaxoSmithKline plc. (study 209016).