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Impact of multiple-dose versus single-dose inhaler devices on COPD patients' persistence with long-acting β₂-agonists: a dispensing database analysis.

van Boven JF, van Raaij JJ, van der Galiën R, Postma MJ, van der Molen T, Dekhuijzen PN, Vegter S - NPJ Prim Care Respir Med (2014)

Bottom Line: Study outcomes were 1-year persistence and switching patterns.There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76-1.26, P=0.99).Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year.

View Article: PubMed Central - PubMed

Affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.

ABSTRACT

Background: With a growing availability of different devices and types of medication, additional evidence is required to assist clinicians in prescribing the optimal medication in relation to chronic obstructive pulmonary disease (COPD) patients' persistence with long-acting β2-agonists (LABAs).

Aims: To assess the impact of the type of inhaler device (multiple-dose versus single-dose inhalers) on 1-year persistence and switching patterns with LABAs.

Methods: A retrospective observational cohort study was performed comparing a cohort of patients initiating multiple-dose inhalers and a cohort initiating single-dose inhalers. The study population consisted of long-acting bronchodilator naive COPD patients, initiating inhalation therapy with mono-LABAs (formoterol, indacaterol or salmeterol). Analyses were performed using pharmacy dispensing data from 1994 to 2012, obtained from the IADB.nl database. Study outcomes were 1-year persistence and switching patterns. RESULTS were adjusted for initial prescriber, initial medication, dosing regimen and relevant comorbidities.

Results: In all, 575 patients initiating LABAs were included in the final study cohort. Among them, 475 (83%) initiated a multiple-dose inhaler and 100 (17%) a single-dose inhaler. Further, 269 (47%) initiated formoterol, 9 (2%) indacaterol and 297 (52%) salmeterol. There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76-1.26, P=0.99). Over 80% re-started or switched medication.

Conclusions: There seems no impact of inhaler device (multiple-dose versus single-dose inhalers) on COPD patients' persistence with LABAs. Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year.

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Related in: MedlinePlus

Switching patterns after the first 60-day gap in patients with at least two dispenses and 2 years follow-up: single-dose versus multiple-dose inhalers. LABA, long-acting β2-agonist; ICS, inhaled corticosteriod; LAMA, long-acting muscarinic antagonist; DPI, dry-powder inhaler; pMDI, pressurised metered-dose inhaler.
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fig4: Switching patterns after the first 60-day gap in patients with at least two dispenses and 2 years follow-up: single-dose versus multiple-dose inhalers. LABA, long-acting β2-agonist; ICS, inhaled corticosteriod; LAMA, long-acting muscarinic antagonist; DPI, dry-powder inhaler; pMDI, pressurised metered-dose inhaler.

Mentions: Figure 4 shows the switching patterns of non-persistent patients after their first 60-days gap. Note that the switching analysis was performed in a subcohort (N=307) with at least two dispensings for long-acting bronchodilators (that is, one-time users are not included) and a follow-up of at least 2 years from treatment initiation. In this cohort, 38 out of 53 single-dose inhaler users were non-persistent and 203 out of 254 multiple-dose inhaler users. From Figure 4 it is shown that ~40% of all patients (disregarding their inhaler type) re-started their initial therapy within 1 year after their first gap. Less than 19% of the patients with a gap did permanently discontinue any type of long-acting respiratory therapy. A considerable percentage of patients switched to fixed dose inhalers of LABA and ICS. Of the single-dose inhaler users, 11% switched to multiple-dose inhalers of the same medication, whereas none of the multiple-dose inhaler users switched to single-dose inhalers with the same medication.


Impact of multiple-dose versus single-dose inhaler devices on COPD patients' persistence with long-acting β₂-agonists: a dispensing database analysis.

van Boven JF, van Raaij JJ, van der Galiën R, Postma MJ, van der Molen T, Dekhuijzen PN, Vegter S - NPJ Prim Care Respir Med (2014)

Switching patterns after the first 60-day gap in patients with at least two dispenses and 2 years follow-up: single-dose versus multiple-dose inhalers. LABA, long-acting β2-agonist; ICS, inhaled corticosteriod; LAMA, long-acting muscarinic antagonist; DPI, dry-powder inhaler; pMDI, pressurised metered-dose inhaler.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373462&req=5

fig4: Switching patterns after the first 60-day gap in patients with at least two dispenses and 2 years follow-up: single-dose versus multiple-dose inhalers. LABA, long-acting β2-agonist; ICS, inhaled corticosteriod; LAMA, long-acting muscarinic antagonist; DPI, dry-powder inhaler; pMDI, pressurised metered-dose inhaler.
Mentions: Figure 4 shows the switching patterns of non-persistent patients after their first 60-days gap. Note that the switching analysis was performed in a subcohort (N=307) with at least two dispensings for long-acting bronchodilators (that is, one-time users are not included) and a follow-up of at least 2 years from treatment initiation. In this cohort, 38 out of 53 single-dose inhaler users were non-persistent and 203 out of 254 multiple-dose inhaler users. From Figure 4 it is shown that ~40% of all patients (disregarding their inhaler type) re-started their initial therapy within 1 year after their first gap. Less than 19% of the patients with a gap did permanently discontinue any type of long-acting respiratory therapy. A considerable percentage of patients switched to fixed dose inhalers of LABA and ICS. Of the single-dose inhaler users, 11% switched to multiple-dose inhalers of the same medication, whereas none of the multiple-dose inhaler users switched to single-dose inhalers with the same medication.

Bottom Line: Study outcomes were 1-year persistence and switching patterns.There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76-1.26, P=0.99).Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year.

View Article: PubMed Central - PubMed

Affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.

ABSTRACT

Background: With a growing availability of different devices and types of medication, additional evidence is required to assist clinicians in prescribing the optimal medication in relation to chronic obstructive pulmonary disease (COPD) patients' persistence with long-acting β2-agonists (LABAs).

Aims: To assess the impact of the type of inhaler device (multiple-dose versus single-dose inhalers) on 1-year persistence and switching patterns with LABAs.

Methods: A retrospective observational cohort study was performed comparing a cohort of patients initiating multiple-dose inhalers and a cohort initiating single-dose inhalers. The study population consisted of long-acting bronchodilator naive COPD patients, initiating inhalation therapy with mono-LABAs (formoterol, indacaterol or salmeterol). Analyses were performed using pharmacy dispensing data from 1994 to 2012, obtained from the IADB.nl database. Study outcomes were 1-year persistence and switching patterns. RESULTS were adjusted for initial prescriber, initial medication, dosing regimen and relevant comorbidities.

Results: In all, 575 patients initiating LABAs were included in the final study cohort. Among them, 475 (83%) initiated a multiple-dose inhaler and 100 (17%) a single-dose inhaler. Further, 269 (47%) initiated formoterol, 9 (2%) indacaterol and 297 (52%) salmeterol. There was no significant difference in persistence between users of multiple-dose or single-dose inhalers (hazard ratio: 0.98, 95% confidence interval: 0.76-1.26, P=0.99). Over 80% re-started or switched medication.

Conclusions: There seems no impact of inhaler device (multiple-dose versus single-dose inhalers) on COPD patients' persistence with LABAs. Over 80% of patients who initially seemed to discontinue LABAs, re-started their initial medication or switched inhalers or medication within 1 year.

Show MeSH
Related in: MedlinePlus