The inevitable drift to triple therapy in COPD

an analysis of prescribing pathways in the UK

Guy Brusselle, David Price, Kevin Gruffydd-Jones, Marc Miravitlles, Dorothy L Keininger, Rebecca Stewart, Michael Baldwin, Rupert C Jones

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)2207-2217
Number of pages11
JournalInternational journal of chronic obstructive pulmonary disease
Volume10
Issue number1
Early online date15 Oct 2015
DOIs
Publication statusPublished - 2015

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Chronic Obstructive Pulmonary Disease
Bronchodilator Agents
Therapeutics
Prescriptions
Adrenal Cortex Hormones
Asthma
History
Inappropriate Prescribing
Muscarinic Antagonists
National Institutes of Health (U.S.)
Dyspnea
Biomedical Research
Primary Health Care
Patient Care

Keywords

  • chronic obstructive pulmonary disease
  • GOLD guidelines
  • observational study
  • prescribing patterns
  • primary care

Cite this

The inevitable drift to triple therapy in COPD : an analysis of prescribing pathways in the UK. / Brusselle, Guy; Price, David; Gruffydd-Jones, Kevin; Miravitlles, Marc; Keininger, Dorothy L; Stewart, Rebecca; Baldwin, Michael; Jones, Rupert C.

In: International journal of chronic obstructive pulmonary disease , Vol. 10, No. 1, 2015, p. 2207-2217.

Research output: Contribution to journalArticle

Brusselle, G, Price, D, Gruffydd-Jones, K, Miravitlles, M, Keininger, DL, Stewart, R, Baldwin, M & Jones, RC 2015, 'The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK', International journal of chronic obstructive pulmonary disease , vol. 10, no. 1, pp. 2207-2217. https://doi.org/10.2147/COPD.S91694
Brusselle, Guy ; Price, David ; Gruffydd-Jones, Kevin ; Miravitlles, Marc ; Keininger, Dorothy L ; Stewart, Rebecca ; Baldwin, Michael ; Jones, Rupert C. / The inevitable drift to triple therapy in COPD : an analysis of prescribing pathways in the UK. In: International journal of chronic obstructive pulmonary disease . 2015 ; Vol. 10, No. 1. pp. 2207-2217.
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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.",
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author = "Guy Brusselle and David Price and Kevin Gruffydd-Jones and Marc Miravitlles and Keininger, {Dorothy L} and Rebecca Stewart and Michael Baldwin and Jones, {Rupert C}",
note = "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.",
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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.

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KW - GOLD guidelines

KW - observational study

KW - prescribing patterns

KW - primary care

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JO - International journal of chronic obstructive pulmonary disease

JF - International journal of chronic obstructive pulmonary disease

SN - 1176-9106

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ER -