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Patient-reported outcomes of dual bronchodilator fixed-dose combination versus bronchodilator monotherapy in individuals with COPD

Authors Strange C, Walker V, DePietro M, Tong J, Kurlander J, Carlyle M, Millette LA, Wittbrodt E

Received 16 November 2018

Accepted for publication 12 April 2019

Published 28 June 2019 Volume 2019:14 Pages 1377—1388

DOI https://doi.org/10.2147/COPD.S194856

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell


Charlie Strange,1 Valery Walker,2 Michael DePietro,3 Junliang Tong,2 Jonathan Kurlander,2 Maureen Carlyle,2 Lauren A Millette,3 Eric Wittbrodt4

1Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA; 2Health Economics and Outcomes Research, Optum, Inc., Eden Prairie, MN, USA; 3US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 4Health Economics and Outcomes Research, AstraZeneca, Wilmington, DE, USA

Background: This study compared real-world patient-reported outcomes (PROs) measured by the Clinical COPD Questionnaire (CCQ), the London Chest Activities of Daily Living (LCADL) scale, and the Work Productivity and Activity Impairment (WPAI) questionnaire between individuals with COPD initiating LAMA/LABA fixed-dose combination (FDC) dual therapy versus either long-acting muscarinic antagonist (LAMA) or long-acting beta2-agonist (LABA) monotherapy.
Methods: Individuals with COPD aged ≥40 years initiating a LAMA/LABA FDC dual therapy or a LAMA or LABA monotherapy (index date = first prescription date) between January 1, 2016 and December 31, 2016 were identified from a large US administrative claims database. Individuals were excluded if they were prescribed an inhaled corticosteroid (ICS) or ICS/LABA two months prior to the index date or were diagnosed with cystic fibrosis, idiopathic pulmonary fibrosis, or asthma. The cohorts were propensity score matched (PSM) 1:1 for COPD severity using baseline measures. Each participant completed a survey.
Results: Surveys were completed by 399 participants in the dual therapy cohort, and 718 participants in the monotherapy cohort. Following PSM, 379 participants remained in each cohort for analysis (monotherapy: 369 LAMA and 10 LABA). The dual therapy cohort reported fewer COPD-related symptoms (CCQ symptom score 2.75 vs 2.97, respectively, P=0.023), and, fewer limitations in leisure activities (LCADL leisure score 4.78 vs 5.17, respectively, P=0.021) versus the monotherapy cohort. No significant differences were found in the WPAI. A greater percentage of participants in the dual therapy cohort stayed on index therapy (63.1%) when compared with the monotherapy cohort (30.3%, P<0.0001).
Conclusions: Only 30% of the participants prescribed monotherapy, usually with a LAMA, remained on index therapy alone at the time of survey administration. In the dual therapy cohort, 63% of the participants remained on the index medication and had fewer COPD-related symptoms and fewer limitations in leisure activities compared with participants in the monotherapy cohort.

Keywords: muscarinic antagonist, adrenergic beta-agonist, surveys and questionnaires, pulmonary disease, chronic obstructive

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