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Clinical characteristics and medication patterns in patients with COPD prior to initiation of triple therapy with ICS/LAMA/LABA: A retrospective study

Michael Bogart, Richard H Stanford, Tyler Reinsch, et al.
Respir Med 2018;142:73–80

Long-acting bronchodilation with a long-acting muscarinic antagonist (LAMA), long-acting beta-2 agonist (LABA) or combination of the two is the foundation of chronic obstructive pulmonary disease (COPD) pharmacological treatment. For some patients, however, this is not enough, and symptom burden or risk of exacerbation drive the escalation to multiple bronchodilators plus an inhaled corticosteroid (ICS). Triple therapy with ICS/LAMA/LABA is currently recommended for patients taking bronchodilator therapy with persistent symptoms or who are at high risk for future exacerbations.

This retrospective study identified patients with a diagnosis of COPD from a US health insurance database between January 2014 and March 2016. The ‘index date’ was the first appearance in the patient’s record of a dispensing overlap of the three drug classes (ICS, LABA and LAMA), which completed the triple therapy combination. A total of 69,743 patients were initially identified; after applying inclusion and exclusion criteria, 13,701 patients were considered first-time users of triple therapy and their records further examined.

Nearly all patients – 95.7% – initiated triple therapy using a LAMA and a fixed-dose ICS/LABA inhaler. The number of patients with prescriptions for one or two medication classes increased in the time period leading up to the index date.

More than half (59.8%) of patients had at least one moderate or severe exacerbation during the study period, and 6.4% had a severe exacerbation. Only 9.6% of patients initiated triple therapy as their first treatment, i.e. without having been treated with an ICS, LABA or LAMA, or experienced an exacerbation, during the baseline period.

In conclusion, the results of this study indicate that most patients receiving triple therapy did so after prior treatment with at least one maintenance medication, or after a moderate or severe exacerbation, in line with current treatment guidelines. Limitations in the study data do not permit further analysis of the 9.6% who started immediately on triple therapy, but the authors postulate this could have been due to persistent patient-reported symptoms, mild exacerbations or spirometry findings.

This study was funded by GlaxoSmithKline.

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