CONTEXT: Peer reviewed paper on Real-World treatment patterns in chronic obstructive pulmonary disease (COPD) | UK general practice data only
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1. “Another retrospective EHR study in the UK of LAMA monotherapy users found 43.6% received treatment escalation at a mean of 325 days after LAMA initiation.9. The recent FULFIL and IMPACT clinical trials evaluated once-daily ICS/LAMA/LABA SITT versus twice-daily ICS/LABA dual therapy (FULFIL), or versus once-daily ICS/LABA and LAMA/LABA dual therapies (IMPACT) in patients with COPD.”
2. “Short- and long-acting bronchodilators, including anticholinergics (short-acting muscarinic antagonists [SAMA] or long-acting muscarinic antagonists [LAMA]) and β ‑agonists (short-acting β -agonists [SABA] or long-acting β -agonists [LABA]), are indicated for symptomatic relief and maintenance, while inhaled corticosteroids (ICS) are added for more severe disease associated with recurrent acute exacerbation of COPD (AECOPD).2. Triple therapy, a combination of ICS, LAMA, and LABA, is a recommended treatment option for patients with COPD who remain symptomatic or experience an AECOPD despite being treated with dual bronchodilators (GOLD D classification).2 COPD patients may also step-up to triple therapy following a concurrent diagnosis of asthma or worsening of symptoms.3 Until recently, triple therapy has only been available through treatment with multiple inhalers (multiple-inhaler triple therapy [MITT]); however, single-inhaler triple therapies (SITT) are now also approved in several regions, including Europe4,5 and the US.6 Past observational research has shown that most patients step up to MITT from an ICS/LABA combination or from LAMA monotherapy due to unsatisfactory improvements in symptoms.7–10 However, there is sparse evidence on real-world use of MITT once initiated, including duration of use and treatment patterns, specifically what treatments patients are using beforehand, and subsequent treatment after MITT discontinuation.”
3. “A previous retrospective, electronic health record (EHR) study conducted in the UK found that, shortly after an initial COPD diagnosis, 19% of the patients classified as GOLD A (GOLD 2013 classification), 28% of GOLD B, 37% of GOLD C, and 46% of GOLD D were prescribed MITT.10 In addition, almost 100% of the patients with COPD in this cohort stepped up to MITT by the eighth year after their initial COPD diagnosis.”
4. “This current study aims to describe MITT use in patients with COPD in a UK primary care setting, prior to availability of single-inhaler regimens, including duration of therapy, clinical characteristics of patients who initiated inhaled triple therapy, and patient and disease factors that contribute to the pattern of prescribing and persistence of use.”
5. “This observational study employed a retrospective cohort design to identify patients with COPD who initiated MITT treatment between June 2013 and June 2015 as recorded in the UK Clinical Practice Research Datalink (CPRD).”