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The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK.

Brusselle G, Price D, Gruffydd-Jones K, Miravitlles M, Keininger DL, Stewart R, Baldwin M, Jones RC - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: The most common prescription pathway to TT was LABA plus ICS.It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium ; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands ; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands.

ABSTRACT

Background: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT.

Methods: This was a historical analysis of COPD patients without asthma from the Optimum Patient Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. Patient disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after COPD diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council dyspnea score, and exacerbation history on the pathway to TT.

Results: During the study period, 32% of patients received TT. Of these, 19%, 28%, 37%, and 46% of patients classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P<0.001). Of all patients prescribed TT, 25% were prescribed TT within 1 year of diagnosis, irrespective of GOLD classification (P=0.065). The most common prescription pathway to TT was LABA plus ICS. It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.

Conclusion: Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of COPD guidelines to physicians, ensuring that patients receive the recommended therapy.

No MeSH data available.


Related in: MedlinePlus

Cumulative proportion of patients receiving triple therapy by GOLD group (2002–2010).Note:P=0.065 (chi-square test).Abbreviation: GOLD, Global initiative for chronic Obstructive Lung Disease.
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f2-copd-10-2207: Cumulative proportion of patients receiving triple therapy by GOLD group (2002–2010).Note:P=0.065 (chi-square test).Abbreviation: GOLD, Global initiative for chronic Obstructive Lung Disease.

Mentions: Analysis of the time to TT demonstrated that 25% of patients who progressed to TT did so within 1 year after diagnosis (GOLD A: 26%; GOLD B: 22%; GOLD C: 24%; and GOLD D: 28%; P=0.065) (Figure 2). Within 2 years of initial diagnosis, >40% of patients progressed to TT (GOLD A: 46%; GOLD B: 39%; GOLD C: 42%; and GOLD D: 47%; Figure 2), with >50% of patients progressing to TT within 3 years after diagnosis (GOLD A: 62%; GOLD B: 57%; GOLD C: 60%; and GOLD D: 64%; P=0.065) (Figure 2). Almost 100% of patients who progressed to TT in GOLD A, B, C, and D did so within 8 years after initial diagnosis (Figure 2).


The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK.

Brusselle G, Price D, Gruffydd-Jones K, Miravitlles M, Keininger DL, Stewart R, Baldwin M, Jones RC - Int J Chron Obstruct Pulmon Dis (2015)

Cumulative proportion of patients receiving triple therapy by GOLD group (2002–2010).Note:P=0.065 (chi-square test).Abbreviation: GOLD, Global initiative for chronic Obstructive Lung Disease.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4621207&req=5

f2-copd-10-2207: Cumulative proportion of patients receiving triple therapy by GOLD group (2002–2010).Note:P=0.065 (chi-square test).Abbreviation: GOLD, Global initiative for chronic Obstructive Lung Disease.
Mentions: Analysis of the time to TT demonstrated that 25% of patients who progressed to TT did so within 1 year after diagnosis (GOLD A: 26%; GOLD B: 22%; GOLD C: 24%; and GOLD D: 28%; P=0.065) (Figure 2). Within 2 years of initial diagnosis, >40% of patients progressed to TT (GOLD A: 46%; GOLD B: 39%; GOLD C: 42%; and GOLD D: 47%; Figure 2), with >50% of patients progressing to TT within 3 years after diagnosis (GOLD A: 62%; GOLD B: 57%; GOLD C: 60%; and GOLD D: 64%; P=0.065) (Figure 2). Almost 100% of patients who progressed to TT in GOLD A, B, C, and D did so within 8 years after initial diagnosis (Figure 2).

Bottom Line: The most common prescription pathway to TT was LABA plus ICS.It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, University Hospital Ghent, Ghent, Belgium ; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands ; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands.

ABSTRACT

Background: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT.

Methods: This was a historical analysis of COPD patients without asthma from the Optimum Patient Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. Patient disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after COPD diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council dyspnea score, and exacerbation history on the pathway to TT.

Results: During the study period, 32% of patients received TT. Of these, 19%, 28%, 37%, and 46% of patients classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P<0.001). Of all patients prescribed TT, 25% were prescribed TT within 1 year of diagnosis, irrespective of GOLD classification (P=0.065). The most common prescription pathway to TT was LABA plus ICS. It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.

Conclusion: Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of COPD guidelines to physicians, ensuring that patients receive the recommended therapy.

No MeSH data available.


Related in: MedlinePlus