Prescribing Pathways to Triple Therapy: A Multi-Country, Retrospective Observational Study of Adult Patients with Chronic Obstructive Pulmonary Disease

• Published in: Pulmonary therapy Vol. 6; no. 2; pp. 333 - 350
• Main Authors: Quint, Jennifer K., O’Leary, Caroline, Venerus, Alessandra, Myland, Melissa, Holmgren, Ulf, Varghese, Precil, Richter, Hartmut, Bizouard, Geoffray, Cabrera, Claudia
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.12.2020; Adis, Springer Healthcare
• Subjects: Adherence; Chronic obstructive pulmonary disease; Family Medicine; General Practice; Internal Medicine; Medicine; Medicine & Public Health; Original Research; Patient pathways; Pharmacoeconomics and Health Outcomes; Pharmacotherapy; Pneumology/Respiratory System; Quality of Life Research; Real-world; Retrospective study; Stepping down; Adherence; Stepping down; Real-world; Treatment initiation; Chronic obstructive pulmonary disease; Retrospective study; Patient pathways; Triple therapy
• ISSN: 2364-1754; 2364-1746
• DOI: 10.1007/s41030-020-00132-7

Introduction Maintenance treatment strategies in COPD recommend inhaled corticosteroid (ICS) + long-acting muscarinic antagonist (LAMA) + long-acting β 2 -agonist (LABA) triple therapy after initial dual therapy. Little is known about how treatment pathways to triple therapy vary across countries in clinical practice. Methods This multi-country, retrospective cohort study (conducted 1 January 2005–1 May 2016) included patients with a COPD diagnosis, and (UK only) evidence of smoking history, or (France, Italy, Germany, and Australia) an indicator confirming COPD diagnosis, a first instance of triple therapy recorded during the study period and ≥ 12 months of data prior to this date. Treatment pathways to triple therapy were analyzed in patients whose first instance of triple therapy was on or after the initial COPD diagnosis. The proportion of patients who initiated triple therapy prior to initial COPD diagnosis was also estimated. Meta-analyses of the main results were performed. Results In 130,729 patients across all countries, mean age (standard deviation) ranged from 63.4 (10.4) years (Germany) to 69.8 (9.9) years (Italy), and median time (interquartile range) from initial COPD diagnosis to first prescription of triple therapy ranged from 16.9 (5.7–36.2) months (Australia) to 42.5 (13.9–87.4) months (UK). ICS + LABA was the most common treatment pathway prior to triple therapy in the UK, Germany, and Italy (27.3%–31.6%); no previous maintenance therapy prior to triple therapy was the most common pathway in France and Australia (32.5% and 37.9%, respectively). Meta-analyses provided a pooled estimate of 20.4% (95% confidence interval: 13.8%–29.1%) for the proportion of patients initiating triple therapy at or before initial COPD diagnosis. Conclusions In this retrospective cohort study, treatment pathways to triple therapy were diverse within and between countries. The differing impact of treatments may affect quality of life and disease control in patients with COPD. Further analyses should investigate factors influencing pathways to triple therapy.