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. 2016 Nov 3:26:16061.
doi: 10.1038/npjpcrm.2016.61.

First maintenance therapy for COPD in the UK between 2009 and 2012: a retrospective database analysis

David Price  1 , Marc Miravitlles  2 , Ian Pavord  3 , Mike Thomas  4 , Jadwiga Wedzicha  5 , John Haughney  1 , Katsiaryna Bichel  6 , Daniel West  6
Affiliations

First maintenance therapy for COPD in the UK between 2009 and 2012: a retrospective database analysis

David Price et al. NPJ Prim Care Respir Med. .

Abstract

Clinical guidelines recommend long-acting bronchodilators as first maintenance therapy for chronic obstructive pulmonary disease (COPD), with inhaled corticosteroids (ICS) reserved for patients with more severe disease and exacerbations. The aim of this analysis was to examine real-life prescribing of first maintenance therapy for COPD in the UK. Data were extracted from the UK Optimum Patient Care Research Database for patients with a first prescription for COPD maintenance therapy between 2009 and 2012 and a diagnosis of COPD at or before the date of the first prescription for COPD maintenance therapy. Routine clinical data including demographics, disease history and symptoms, comorbidities, therapy, hospitalisation rate and exacerbation rate were collected and used to characterise patients stratified by disease severity and Global Initiative for Chronic Obstructive Lung Disease (GOLD) group (A-D). The analysis population included 2,217 individuals (55.4% male, 45.2% smokers). Long-acting muscarinic antagonists (LAMA) as monotherapy were prescribed as first maintenance therapy for 40.2% of patients. ICS were prescribed as ICS/long-acting beta-agonists combination for 29.1% of patients or as monotherapy for 15.5%. ICS (alone or in combination) were prescribed to >40% of patients in each GOLD group. ICS-containing regimens were prescribed to patients with a history of pneumonia and comorbid conditions for whom the risks of ICS therapy may outweigh the benefits. The clinical reality of prescribing indicates that ICS are often prescribed outside current guideline recommendations for many patients newly diagnosed with COPD in the UK. Encouragingly, LAMAs are increasingly being prescribed as first maintenance therapy for these patients.

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Conflict of interest statement

DP has acted as a consultant for Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline (GSK), Meda, Mundipharma, Napp, Novartis, Pfizer and Teva. He has received research grants from the UK National Health Service, the British Lung Foundation, Aerocrine, AstraZeneca, Boehringer Ingelheim, Chiesi, Eli Lilly, GSK, Meda, Merck, Mundipharma, Novartis, Orion, Pfizer, Respiratory Effectiveness Group, Takeda, Teva and Zentiva. He owns shares in AKL Ltd, which produced phytopharmaceuticals and owns 80% of RiRL Ltd and its subsidiary social enterprise Optimum Patient Care. He has received unrestricted funding for investigator-initiated studies from Aerocrine, AKL Ltd, Almirall, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, Orion, Takeda, Teva and Zentiva. MM has received speaker fees from Almirall, Boehringer Ingelheim, Pfizer, AstraZeneca, Chiesi, Esteve, GSK, Menarini, Grifols, Mycomed and Novartis, and has received consulting fees from Almirall, Boehringer Ingelheim, Pfizer, GSK, Gebro Pharma, CLS Behring, MedImmune, Novartis, Grifols and Nycomed. In the last 5 years, IP has received speaker’s honoraria for speaking at sponsored meetings from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis and GSK, and a payment for organising an educational event for SPRs from AstraZeneca. He has received honoraria for attending advisory panels with Almirall, Genentech, Regeneron, AstraZeneca, Boehringer Ingelheim, GSK, Merck Sharp and Dohme (MSD), Schering-Plough, Novartis, Dey, Napp and Respivert. He has received sponsorship to attend international scientific meetings from Boehringer Ingelheim, GSK, AstraZeneca and Napp. Neither MT nor any member of his close family has any shares in pharmaceutical companies. In the last 3 years he has received speaker’s honoraria for speaking at sponsored meetings or satellite symposia at conferences from the following companies marketing respiratory and allergy products: Aerocrine, AstraZeneca, Boehringer Ingelheim, GSK, MSD and Teva. He has received honoraria for attending advisory panels with Aerocrine, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, MSD and Novartis. He has received sponsorship to attend international scientific meetings from GSK, AstraZeneca and Mundipharma. He has received funding for research projects from GSK and Almirall. He is chief medical adviser to the charity Asthma UK, a member of the BTS SIGN Asthma guideline group and the NICE Asthma guideline group. JW has received research grants from GSK, Takeda, Almirall, Novartis, Johnson and Johnson and Vifor Pharma, honoraria for advisory boards for Almirall, Novartis, GSK, Boehringer, Takeda, Johnson and Johnson, Napp, Pfizer and AstraZeneca, and lecture/presentation fees from Almirall, Novartis, GSK, Boehringer and Takeda. JH has received reimbursement for attending symposia, fees for speaking, organising educational events, funds for research or fees for consulting from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GSK, MSD, Mundipharma, Novartis and Teva. KB and DW were employees of RiRL Ltd at the time of the study.

Figures

Figure 1
Figure 1
Consort diagram. COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; OPCRD, Optimum Patient Care Research Database.
Figure 2
Figure 2
Prescribing pattern for first major therapy class within each GOLD group. GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.
Figure 3
Figure 3
Distribution of comorbidities within each GOLD group. CKD, chronic kidney disease; GERD, gastro-oesophageal reflux disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease.
Figure 4
Figure 4
Distribution of comorbidities within each first major therapy class. Proportions are calculated based on the total number of patients reporting each comorbidity and plotted across the first therapy class. CKD, chronic kidney disease; GERD, gastro-oesophageal reflux disease; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.
See this image and copyright information in PMC

References

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