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Observational Study
. 2018 Dec 18:14:51-63.
doi: 10.2147/COPD.S181224. eCollection 2019.

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners

Wilhelmine Meeraus  1 , Robert Wood  2 , Rafal Jakubanis  2 , Tim Holbrook  2 , Geoffray Bizouard  3 , Johanna Despres  3 , Camille Correia Da Silva  4 , Gaelle Nachbaur  4 , Sarah H Landis  1 , Yogesh Punekar  5 , Bernard Aguilaniu  6 , Afisi S Ismaila  7   8
Affiliations
Observational Study

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners

Wilhelmine Meeraus et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Increasing availability of therapeutic options for COPD may drive new treatment pathways. This study describes COPD treatment in France, focusing on identifying initial treatment modifications in patients with COPD who either initiated long-acting bronchodilator (LABD)-based therapy or escalated to triple therapy (long-acting muscarinic antagonist [LAMA] + long-acting β2-agonist [LABA] + inhaled corticosteroid [ICS]).

Methods: This retrospective analysis of patients with COPD in a large general practitioner database (IQVIA Longitudinal Patient Database) in France included two cohorts: Cohort 1 - new initiators of LABD-based therapy (LAMA, LABA, LAMA + LABA, LAMA + ICS, LABA + ICS or LAMA + LABA + ICS); Cohort 2 - patients escalating to triple therapy from mono- or dual-bronchodilator-based maintenance treatment. Both cohorts were indexed on the date of initiation/escalation (January 2008-December 2013), and the first treatment modification (at class level) within the 18-month post-index observational period was described. Five mutually exclusive outcomes were defined: continuous use (no modification), discontinuation (permanent [≥91 days with no restart] or temporary [≥91 days with subsequent restart]), switch, and augmentation (Cohort 1 only). Exploratory analysis of Cohort 1 explored potential drivers of treatment initiation.

Results: Overall, 5,065 patients initiated LABD-based therapy (Cohort 1), and 501 escalated to triple therapy (Cohort 2). In Cohort 1, 7.0% of patients were continuous users, 46.5% discontinued permanently, 28.5% discontinued temporarily, 2.8% augmented (added LAMA and/or LABA and/or ICS), and 15.2% switched therapy. In Cohort 2, 18.2% of patients were continuous users, 7.2% discontinued permanently, 27.9% discontinued temporarily, and 46.7% switched therapy. Exploratory analyses showed that time since COPD diagnosis was first recorded, pre-index exacerbation events, and concomitant medical conditions were potential drivers of initial maintenance treatment choices.

Conclusion: Discontinuation among new initiators of LABD-based therapy was high in France, whereas few switched or augmented treatment. In comparison, permanent discontinuation within 18 months was low in patients escalating to triple therapy.

Keywords: France; maintenance therapy; treatment modification; treatment pathways; triple therapy.

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Conflict of interest statement

Disclosure WM, CCDS, GN, YP, SHL, and ASI are employees of GSK and own stocks/shares. ASI is also an unpaid faculty member at McMaster University, Hamilton, ON, Canada. RW, RJ, and TH are employees of Adelphi Real World, and GB and JD are employees of IQVIA who were contracted by GSK to conduct the study. BA has received consultant fees and/or research funds from Boehringer Ingelheim, GSK, Chiesi, Astra Zeneca, Pierre Fabre, and Roche. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
CONSORT diagram for patients initiating maintenance treatment (long-acting bronchodilator-based therapy) at index (Cohort 1) and patients escalating to triple therapy at index (Cohort 2). Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting ®2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 3
Figure 3
First treatment modification within the 18-month post-index observational period for patients initiating maintenance treatment (long-acting bronchodilator-based therapy) at index (Cohort 1) and patients escalating to triple therapy at index (Cohort 2). Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting ®2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 4
Figure 4
Treatment received after switching in patients initiating maintenance treatment (long-acting bronchodilator-based therapy) at index (Cohort 1) and patients escalating to triple therapy at index (Cohort 2). Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting ®2-agonist; LAMA, long-acting muscarinic antagonist.
Figure 5
Figure 5
Exploratory multiple correspondence analysis and treatment clusters identified in the hierarchical cluster analysis. Notes: Final visualization of the exploratory multiple correspondence analysis of factors potentially driving treatment initiation, with overlay of the treatment clusters identified in the hierarchical cluster analysis. Circles represent the four clusters defined in the hierarchical cluster analysis (Elbow method). Variables (patient demographics and patient characteristics) represented by dots in each dimension (1 and 2) were identified in multiple correspondence analysis. The two dimensions accounted for ~90% of the information. Cluster 1 included LAMA + LABA, cluster 2 included LAMA and LABA, cluster 3 included LAMA + ICS and triple therapy (LAMA + LABA + ICS), and cluster 4 included LABA + ICS. Abbreviations: GERD, gastroesophageal reflux disease; ICS, inhaled corticosteroid; LABA, long-acting ®2-agonist; LAMA, long-acting muscarinic antagonist; N, no; Y, yes.
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