PDF(Pubmed)
Abstract：
Triple therapy (long-acting muscarinic antagonist [LAMA] plus long-acting beta2-agonist [LABA] plus inhaled corticosteroid [ICS]) is recommended by the Global initiative for chronic Obstructive Lung Disease (GOLD) for moderate-to-severe chronic obstructive pulmonary disease (COPD) with a history of frequent and/or severe exacerbation(s) and dyspnea while using dual bronchodilators. However, many patients receive triple therapy contrary to these recommendations. This study describes factors associated with GOLD-discordant triple therapy initiation.
This retrospective analysis included patients aged 40 and above, with ≥1 COPD diagnosis, who initiated triple therapy (initiation=index date) during the period January 1, 2014 to December 31, 2018 and had ≥12 months pre-index continuous enrollment (baseline). Triple therapy comprised ≥30 days of overlapping LAMA, LABA, and ICS treatments (open triple therapy), or single-inhaler fluticasone furoate/umeclidinium/vilanterol (closed triple therapy). Cohorts were defined based on the absence of baseline maintenance medication use (\"maintenance-naïve\"), and/or exacerbations (\"exacerbation-discordant\"), or \"dual-discordant\" (discordant on both measures). All triple therapy initiators, overall and for each cohort, were described, and predictors of GOLD-discordant triple therapy initiation were identified.
Among 21,711 triple therapy initiators, 34.4% were maintenance-naïve, 61.9% exacerbation-discordant, and 22.2% dual-discordant. Triple therapy initiation appeared to increase during the period 2016 to 2018. In 2018 alone, 31.9% and 58.3% of open triple therapy patients were maintenance-naïve and exacerbation-discordant, respectively, versus 37.6% and 64.4% of closed triple therapy patients. Closed triple therapy initiators had 1.65 times greater risk of dual discordance than open triple therapy initiators. Exacerbation-discordant patients initiating closed triple therapy were 1.61 times more likely to be maintenance-naïve than those initiating open triple therapy.
A substantial proportion of COPD patients initiating triple therapy do not meet GOLD recommendations regarding exacerbation history and/or prior maintenance therapy. Compared with open triple therapy, closed triple therapy initiators were more likely to be dual discordant.
This retrospective analysis included patients aged 40 and above, with ≥1 COPD diagnosis, who initiated triple therapy (initiation=index date) during the period January 1, 2014 to December 31, 2018 and had ≥12 months pre-index continuous enrollment (baseline). Triple therapy comprised ≥30 days of overlapping LAMA, LABA, and ICS treatments (open triple therapy), or single-inhaler fluticasone furoate/umeclidinium/vilanterol (closed triple therapy). Cohorts were defined based on the absence of baseline maintenance medication use (\"maintenance-naïve\"), and/or exacerbations (\"exacerbation-discordant\"), or \"dual-discordant\" (discordant on both measures). All triple therapy initiators, overall and for each cohort, were described, and predictors of GOLD-discordant triple therapy initiation were identified.
Among 21,711 triple therapy initiators, 34.4% were maintenance-naïve, 61.9% exacerbation-discordant, and 22.2% dual-discordant. Triple therapy initiation appeared to increase during the period 2016 to 2018. In 2018 alone, 31.9% and 58.3% of open triple therapy patients were maintenance-naïve and exacerbation-discordant, respectively, versus 37.6% and 64.4% of closed triple therapy patients. Closed triple therapy initiators had 1.65 times greater risk of dual discordance than open triple therapy initiators. Exacerbation-discordant patients initiating closed triple therapy were 1.61 times more likely to be maintenance-naïve than those initiating open triple therapy.
A substantial proportion of COPD patients initiating triple therapy do not meet GOLD recommendations regarding exacerbation history and/or prior maintenance therapy. Compared with open triple therapy, closed triple therapy initiators were more likely to be dual discordant.
摘要：
背景：慢性阻塞性肺疾病全球倡议（GOLD）推荐使用三联疗法（长效毒蕈碱拮抗剂[LAMA]加长效β2激动剂[LABA]加吸入皮质类固醇[ICS]）治疗中度至重度慢性阻塞性肺疾病（COPD），同时使用双支气管扩张剂。然而,许多患者接受与这些建议相反的三联疗法。这项研究描述了与GOLD不一致三联疗法开始相关的因素。
方法：这项回顾性分析包括40岁及以上的患者，诊断为COPD≥1次，在2014年1月1日至2018年12月31日期间开始三联疗法(开始日期=指标日期),且指标前连续入组时间≥12个月(基线).三联疗法包括≥30天重叠LAMA，LABA,和ICS治疗（开放三联疗法），或单吸入糠酸氟替卡松/灭替地铵/维兰特罗（封闭三联疗法）。根据缺乏基线维持药物使用(“维持幼稚”)定义队列，和/或恶化（“恶化-不一致”），或“双重不一致”(两种措施都不一致)。所有三联疗法的发起者，总体而言，对于每个队列，被描述,并确定了启动GOLD不一致三联疗法的预测因素。
结果：在21,711个三联疗法的发起者中，34.4%的人是幼稚的，61.9%恶化-不和谐，和22.2%的双重不和谐。在2016年至2018年期间，三联疗法的启动似乎有所增加。仅在2018年，31.9％和58.3％的开放三联疗法患者是维持初期和恶化不一致，分别,封闭三联疗法患者的37.6％和64.4％。封闭式三联疗法发起者的双重不一致风险是开放式三联疗法发起者的1.65倍。开始封闭三联疗法的急性加重不一致患者比开始开放三联疗法的患者更可能是维持初治的1.61倍。
结论：开始三联疗法的大部分COPD患者不符合GOLD关于恶化史和/或先前维持治疗的建议。与开放三联疗法相比，封闭式三联疗法的发起者更可能是双重不一致的.
方法：这项回顾性分析包括40岁及以上的患者，诊断为COPD≥1次，在2014年1月1日至2018年12月31日期间开始三联疗法(开始日期=指标日期),且指标前连续入组时间≥12个月(基线).三联疗法包括≥30天重叠LAMA，LABA,和ICS治疗（开放三联疗法），或单吸入糠酸氟替卡松/灭替地铵/维兰特罗（封闭三联疗法）。根据缺乏基线维持药物使用(“维持幼稚”)定义队列，和/或恶化（“恶化-不一致”），或“双重不一致”(两种措施都不一致)。所有三联疗法的发起者，总体而言，对于每个队列，被描述,并确定了启动GOLD不一致三联疗法的预测因素。
结果：在21,711个三联疗法的发起者中，34.4%的人是幼稚的，61.9%恶化-不和谐，和22.2%的双重不和谐。在2016年至2018年期间，三联疗法的启动似乎有所增加。仅在2018年，31.9％和58.3％的开放三联疗法患者是维持初期和恶化不一致，分别,封闭三联疗法患者的37.6％和64.4％。封闭式三联疗法发起者的双重不一致风险是开放式三联疗法发起者的1.65倍。开始封闭三联疗法的急性加重不一致患者比开始开放三联疗法的患者更可能是维持初治的1.61倍。
结论：开始三联疗法的大部分COPD患者不符合GOLD关于恶化史和/或先前维持治疗的建议。与开放三联疗法相比，封闭式三联疗法的发起者更可能是双重不一致的.
