August 05, 2019
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COPD treatment patterns changing over time

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New data from the COLIBRI-COPD French cohort demonstrate a significant shift in physician prescribing patterns for COPD therapy during the past 6 years.

From 2012 to 2018, investigators noted that the proportion of patients with COPD who received inhaled corticosteroids decreased from 55.6% to 35.9%, and the proportion of patients who did not receive initial maintenance treatment increased from 16.2% to 24.8%. The proportion of patients receiving long-acting beta agonists combined with long-acting muscarinic agents also increased from 11.1% to 23.1%, whereas the proportion of patients who received a LABA or LAMA remained stable.

When assessed according to airflow limitation, the increase in patients who did not receive initial medical treatment was most pronounced for those classified as Global Initiative for chronic obstructive lung disease 1 (GOLD 1; 27.2% to 53.6%; P < .001).

Additionally, results showed decreases from 22.3% to 18.5% in treatment with only one long-acting bronchodilator for patients classified as GOLD 2 (P = .021) and from 3% to 0% for those classified as GOLD 4 (P = .04) during the study period. Treatment with two long-acting bronchodilators, however, increased for those classified as GOLD 2 (P < .001), GOLD 3 (P < .001) and GOLD 4 (P = .015), but not for those classified as GOLD 1 (P = .284).

The researchers also observed a decrease in triple therapy for GOLD 1 (P < .001), GOLD 2 (P = .001) and GOLD 3 (P = .005), but not for GOLD 4 (P = .497).

Furthermore, when assessed according to GOLD 2017 classification, there was an increase from 19.1% to 41.2% in the proportion of patients who did not receive initial maintenance treatment for those classified as GOLD A (P < .001) during the study period. Use of two long-acting bronchodilators also increased for all classifications, but the use of triple therapy, including an LABA plus an LAMA and inhaled corticosteroids, decreased only for GOLD A (35.3% to 11.1%).

The COLIBRI-COPD database at the time of analysis included 4,537 patients with spirometry-confirmed COPD in France. Of these, 3,047 patients could be classified as GOLD 1, 2, 3 or 4 stages and GOLD A, B, C or D groups. The database also included 145 respiratory physicians — 22% of whom worked in private practices and 78% of whom worked in hospitals. Seventy-three percent of those who worked in hospitals were based at tertiary care university hospitals.

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The researchers noted that these changes in practice patterns may arise from the publication of new scientific evidence and changes in guideline recommendations. During the past decade, they wrote, several large randomized controlled trials demonstrated the beneficial effects of LABAs, with or without inhaled corticosteroids and LAMAs, on COPD symptoms and exacerbation rates. Furthermore, LABA plus LAMA became the preferred therapy for GOLD B and C groups and the recommended first-line treatment for GOLD D groups in 2016.

“The results of this study suggest that new evidence from comparative studies and changes in recommendations may have contributed to the rapid impact on physicians’ clinical practice. This finding should trigger Guidelines Committees to update their recommendations quickly after the release of new evidence,” the researchers wrote.

However, they acknowledged that other factors, such as age, sex, comorbidities and additional treatments, may have influenced prescribing patterns and that further analyses would be helpful. – by Melissa Foster

Disclosures: One author reports he has received grants and personal fees from Boehringer Ingelheim, Novartis and Pfizer, and he has received personal fees from 3M, AstraZeneca, Chiesi, Cipla, Mundipharma, Nemera, Sandoz, Sanofi, Trudell and Zambon. A second author reports he has received grants and personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva. All other authors report no relevant financial disclosures.