■关于COPD患者的真实世界治疗模式的文献有限,特别是自2017年开始采用糠酸氟替卡松/米地铵/维兰特罗每日一次单吸入三联疗法以来.这里,我们评估了COPD加重前后COPD患者的治疗模式.
■回顾性,使用Optum®Clinformatics®DataMart数据库中的医疗和药房索赔数据和注册信息进行描述性研究。纳入2017年9月18日或之后年龄≥40岁且COPD加重≥1次的患者。指标日期为首次COPD加重的最后一天(即中度加重的访视日期或重度加重的出院日期)。基线期为索引前12个月,随访期(≥3个月)从索引期至最早的健康计划退出。数据可用性结束(2020年9月30日),或死亡。在基线和随访期间评估治疗模式,重点关注指标前后90天的药物转换。
■在307,727例患者中发现了COPD恶化(125,942例严重;181,785例中度)。平均指数年龄为72.8岁;56.3%为女性。在第一次加重之前和之后,37.7%和48.2%的患者使用≥1控制药物,分别。在90天的预索引中,ICS,LABA,27.5%的患者使用LAMA药物。在这些用户中,64.3%保持在同一药物类别,21.7%停产,14.1%的人在指数后90天内更换药物。在切换者中,44.0%改用三联疗法。最常见的转换是ICS/LABA到ICS/LABA/LAMA(20.7%)和LAMA到ICS/LABA/LAMA(16.4%)。
■许多COPD加重发生在未使用控制药物的患者中。尽管在第一次加重后接受控制药物治疗的患者百分比增加,它仍然低于50%。在恶化前接受控制药物的患者中,只有一小部分在加重后升级为三联疗法.
There is limited literature regarding real-world treatment patterns of patients with COPD, particularly since the introduction of once-daily single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol in 2017. Here, we evaluated treatment patterns of patients with COPD before and after a COPD exacerbation.
Retrospective, descriptive study using medical and pharmacy claims data and enrollment information from the Optum® Clinformatics® Data Mart database. Patients aged ≥40 years with ≥1 COPD exacerbation on or after September 18, 2017 were included. The index date was the last day of the first COPD exacerbation (ie day of visit for a moderate exacerbation or discharge date for a severe exacerbation). The baseline period was 12 months prior to index and the follow-up period (≥3 months) spanned from index until the earliest of health plan disenrollment, end of data availability (September 30, 2020), or death. Treatment patterns were evaluated during baseline and follow-up, with a focus on medication switching in the 90 days pre- and post-index.
COPD exacerbations were identified in 307,727 patients (125,942 severe; 181,785 moderate). Mean age at index was 72.8 years; 56.3% were female. Before and after first exacerbation, 37.7% and 48.2% of patients used ≥1 controller medication, respectively. In the 90 days pre-index, ICS, LABA, and LAMA medications were used by 27.5% of patients. Of these users, 64.3% remained on the same medication class, 21.7% discontinued, and 14.1% switched medication in the 90 days post-index. Among switchers, 44.0% switched to triple therapy. Most common switches were ICS/LABA to ICS/LABA/LAMA (20.7%) and LAMA to ICS/LABA/LAMA (16.4%).
Many COPD exacerbations occur among patients not on controller medications. Although the percentage of patients receiving a controller medication increased following a first exacerbation, it remained below 50%. Of patients receiving controller medications pre-exacerbation, only a small proportion escalated to triple therapy post-exacerbation.