Rates of escalation to triple COPD therapy among incident users of LAMA and LAMA/LABA.
Respir Med
; 139: 65-71, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-29858004
ABSTRACT
BACKGROUND:
Improved outcomes have been reported for patients with chronic obstructive pulmonary disease (COPD) receiving combination long-acting muscarinic antagonist/long-acting ß2-agonist (LAMA/LABA) therapy compared with LAMA monotherapy. However, little is known about the relative characteristics of these patients and their rates of escalation to triple therapy (TT, combining a LAMA, LABA, and inhaled corticosteroid). This study aimed to characterize patients initiating treatment with the LAMA tiotropium (TIO) and the fixed-dose LAMA/LABA combination therapy umeclidinium/vilanterol (UMEC/VI), and to compare rates of escalation to TT between patients receiving these therapies.METHODS:
Retrospective study of patients with COPD enrolled in a US health insurance plan during 2013-2015 and newly initiated on TIO or UMEC/VI. Patients were ≥40 years of age at index (date of therapy initiation) with continuous enrollment for 12 months pre-index and ≥30 days post-index. LAMA users were propensity score matched 11 to LAMA/LABA users, with TT initiation rates reported by cohort using pharmacy claims.RESULTS:
35,357 patients initiating on TIO and 2407 patients initiating on UMEC/VI were identified. After propensity score matching, the rate of TT initiation was significantly higher in new TIO users (nâ¯=â¯1320) than in new UMEC/VI users (nâ¯=â¯1320) (0.92 vs 0.49 per 100 months of exposure, respectively; pâ¯<â¯0.001). Relative to the UMEC/VI cohort, the TIO cohort had an 87% higher risk of TT initiation (hazard ratio 1.87; 95% confidence interval 1.4-2.5; pâ¯=â¯0.001).CONCLUSIONS:
Patients receiving UMEC/VI progressed to TT more slowly, and were at lower risk of progressing to TT, than patients receiving TIO.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Corticosteroides
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Antagonistas Muscarínicos
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Doença Pulmonar Obstrutiva Crônica
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Agonistas de Receptores Adrenérgicos beta 2
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article