A retrospective study to assess clinical characteristics and time to initiation of open-triple therapy among patients with chronic obstructive pulmonary disease, newly established on long-acting mono- or combination therapy
Received 29 November 2016
Accepted for publication 27 March 2017
Published 21 June 2017 Volume 2017:12 Pages 1825—1836
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Douglas Mapel,1 François Laliberté,2 Melissa H Roberts,1,3 Susan R Sama,4 Devi Sundaresan,4 Dominic Pilon,2 Patrick Lefebvre,2 Mei Sheng Duh,5 Jeetvan Patel6
1Health Services Research Division, Lovelace Clinic Foundation, Albuquerque, NM, USA; 2Groupe d’analyse, Montreal, QC, Canada; 3Department of Pharmacy Practice and Administrative Sciences, University of New Mexico, College of Pharmacy, University of New Mexico, Albuquerque, NM, 4Research Department, Reliant Medical Group, Worcester, MA, 5Analysis Group, Boston, MA, 6US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
Introduction: An incremental approach using open-triple therapy may improve outcomes in patients with chronic obstructive pulmonary disease (COPD). However, there is little sufficient, real-world evidence available identifying time to open-triple initiation.
Methods: This retrospective study of patients with COPD, newly initiated on long-acting muscarinic antagonist (LAMA) monotherapy or inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combination therapy, assessed baseline demographics, clinical characteristics, and exacerbations during 12 months prior to first LAMA or ICS/LABA use. Time to initiation of open-triple therapy was assessed for 12 months post-index date. Post hoc analyses were performed to assess the subsets of patients with pulmonary-function test (PFT) information and patients with and without comorbid asthma.
Results: Demographics and clinical characteristics were similar between cohorts in the prespecified and post hoc analyses. In total, 283 (19.3%) and 160 (10.9%) patients had moderate and severe exacerbations at baseline, respectively, in the LAMA cohort, compared with 482 (21.3%) and 289 (12.8%) patients in the ICS/LABA cohort. Significantly more patients initiated open-triple therapy in the LAMA cohort compared with the ICS/LABA cohort (226 [15.4%] versus 174 [7.7%]; P<0.001); results were similar in the post hoc analyses. Mean (standard deviation) time to open-triple therapy was 79.8 (89.0) days in the LAMA cohort and 122.9 (105.4) days in the ICS/LABA cohort (P<0.001). This trend was also observed in the post hoc analyses, though the difference between cohorts was nonsignificant in the subset of patients with PFT information.
Discussion: In this population, patients with COPD are more likely to initiate open-triple therapy following LAMA therapy, compared with ICS/LABA therapy. Further research is required to identify factors associated with the need for treatment augmentation among patients with COPD.
Keywords: COPD, open-triple therapy, long-acting muscarinic antagonists, inhaled corticosteroids, long-acting β-agonists
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