PDF(Pubmed)
Abstract：
This study aimed to define real-world prescription patterns in Korea and compare the effectiveness of chronic obstructive pulmonary disease (COPD) medications. We used national claims data provided by the Health Insurance Review and Assessment Service in Korea and examined patients who were first diagnosed with COPD and started treatment between May 1, 2017, and April 30, 2018, with no change in drug regimen. Among 30,784 patients with COPD, long-acting β2 agonist (LABA) combined with long-acting muscarinic antagonist (LAMA) (32.7%), inhaled corticosteroid-LABA (ICS-LABA) (25.6%), LAMA (18.3%), ICS (5.8%), or LABA (4.6%) were prescribed as the first-choice inhalers. The use of LABA-LAMA (hazard ratio [HR], 0.248-0.584), LAMA (HR, 0.320-0.641), ICS-LABA (HR, 0.325-0.643), and xanthine (HR, 0.563-0.828) significantly reduced the total and severe exacerbation rates compared with no use of each medication. However, the use of ICS or LABA individually did not yield such effects. The continued use of LABA-LAMA, LAMA, and ICS-LABA showed a significant effect on exacerbation rate, whereas the long-term use of ICS, LABA, and xanthine did not. Moreover, some high doses of ICS-LABA did not show significant effects. This real-world study revealed that LAMA and/or LABA could be the first choice of therapy, as recommended by recent guidelines. However, ICS, xanthine, and high-dose ICS-LABA are still being prescribed frequently as first-line drugs in Korea.
摘要：
这项研究旨在定义韩国的真实世界处方模式，并比较慢性阻塞性肺疾病（COPD）药物的有效性。我们使用韩国健康保险审查和评估服务提供的国家索赔数据，并检查了首次诊断为COPD并在2017年5月1日至2018年4月30日期间开始治疗的患者，药物方案没有变化。在30,784例COPD患者中，长效β2激动剂（LABA）联合长效毒蕈碱拮抗剂（LAMA）（32.7%），吸入性皮质类固醇-LABA（ICS-LABA）（25.6%），LAMA（18.3%），ICS（5.8%），或LABA（4.6％）被规定为首选吸入器。LABA-LAMA的使用(危险比[HR]，0.248-0.584），LAMA(HR,0.320-0.641),ICS-LABA(HR,0.325-0.643),和黄嘌呤（HR，0.563-0.828）与不使用每种药物相比，显着降低了总的和严重的恶化率。然而,单独使用ICS或LABA未产生此类效果.继续使用LABA-LAMA，LAMA,ICS-LABA对加重率有显著影响，而ICS的长期使用，LABA,黄嘌呤没有。此外，一些高剂量的ICS-LABA未显示显著作用.这项现实世界的研究表明，LAMA和/或LABA可能是治疗的首选，正如最近的指导方针所建议的那样。然而,ICS,黄嘌呤,在韩国，高剂量ICS-LABA仍经常被处方为一线药物。
