TY - JOUR
T1 - The inevitable drift to triple therapy in COPD
T2 - an analysis of prescribing pathways in the UK
AU - Brusselle, Guy
AU - Price, David
AU - Gruffydd-Jones, Kevin
AU - Miravitlles, Marc
AU - Keininger, Dorothy L
AU - Stewart, Rebecca
AU - Baldwin, Michael
AU - Jones, Rupert C
N1 - Acknowledgments
The analyses reported in this study were funded by Novartis
Pharma AG (Basel, Switzerland) and were conducted by
Research in Real-Life Ltd (Cambridge, UK), an independent
company. The authors also thank David Bergin, Danielle Corbett,
and Vivek Khanna (professional medical writers; Novartis)
for assistance in the preparation of this paper. Writing support
was funded by Novartis Pharma AG.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - chronic obstructive pulmonary disease
KW - GOLD guidelines
KW - observational study
KW - prescribing patterns
KW - primary care
U2 - 10.2147/COPD.S91694
DO - 10.2147/COPD.S91694
M3 - Article
C2 - 26527869
VL - 10
SP - 2207
EP - 2217
JO - International journal of chronic obstructive pulmonary disease
JF - International journal of chronic obstructive pulmonary disease
SN - 1176-9106
IS - 1
ER -