Treatment evolution after COPD diagnosis in the UK primary care setting

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Abstract

Rationale: To assess the treatment progression during the 24 months following a formal diagnosis of chronic obstructive pulmonary disease (COPD) in the UK primary care setting. Methods: A retrospective cohort of newly diagnosed COPD patients was identified in the Clinical Practice Research Datalink (CPRD) from 1/1/2008 until 31/12/2009. Maintenance therapy prescribed within the first 3 months of diagnosis and in the subsequent 3-month intervals for 24 months were analyzed. Treatment classes included long-acting β2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), inhaled corticosteroids (ICSs), and respective combinations. At each 3-month interval, discontinuation, switching, addition, and stepping down patterns were analyzed cumulatively for the first 12 months and over the 24-month of follow-up. Results: A total of 3199 patients with at least one prescription of a maintenance therapy at baseline and during 4th-6th month interval were included in the analysis. At diagnosis (0-3 months), the most frequently prescribed maintenance therapy was LABA+ICS (43%), followed by LAMA (24%) and LABA+LAMA+ICS (23%). Nearly half the patients (LABA-50%, LAMA-43%) starting on a monobronchodilator had additions to their treatment in 24 months. Compared to other medications, patients starting on a LAMA were most likely to escalate to triple therapy in 24 months. Nearly one-fourth of the patients prescribed triple therapy at baseline stepped down to LABA+ICS (25%) or LAMA (31%) within 24 months. Conclusion: Disease progression is evident over the 24 months after COPD diagnosis, as more patients were prescribed additional maintenance therapy in the 24-month period compared to baseline. The changes in therapy suggest that it is difficult to achieve a consistently improved COPD disease state. © 2014 Wurst et al.

Figures

  • Table 1. Patient disposition and demographic characteristics.
  • Figure 1. Maintenance prescriptions at diagnosis. Patients (n = 3199) prescribed maintenance therapy at baseline and 3–6 months excluding patients with no treatment, SABD alone, ICS, and others. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting b2-agonist; LAMA, long-acting muscarinic antagonist. doi:10.1371/journal.pone.0105296.g001
  • Figure 2. Proportions of patients continuing on the same treatment class for 24 months. a To be included in analysis, patients had to receive a prescription at each 3-month interval. Triple, LABA+LAMA+ICS. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting b2-agonist; LAMA, long-acting muscarinic antagonist. doi:10.1371/journal.pone.0105296.g002
  • Figure 3. Percentage of changes in maintenance medications at the end of the 24 months of follow-up. Censored indicates no prescription for a COPD maintenance medication during a 3 month interval. doi:10.1371/journal.pone.0105296.g003
  • Table 4. Percent of patients that progressed to triple therapy within 2 years by index treatment prescribed.

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APA

Wurst, K. E., Punekar, Y. S., & Shukla, A. (2014). Treatment evolution after COPD diagnosis in the UK primary care setting. PLoS ONE, 9(9). https://doi.org/10.1371/journal.pone.0105296

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