Discontinuation of therapy among COPD patients who experience an improvement in exacerbation status

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

PURPOSE: A subset of patients with chronic obstructive pulmonary disease (COPD) experience a decrease in exacerbation frequency, leading to a diminished need for treatment with inhaled corticosteroids (ICS). We investigated prescribing and discontinuation patterns of long-acting bronchodilators and ICS in COPD patients according to exacerbation frequency.

METHODS: Using the nationwide Danish health registries, we conducted a drug utilization study among patients who had at least two exacerbations or one hospitalization due to an exacerbation during 2011-2012. This study population was stratified according to consistency of exacerbation occurrence after 12, 24, 36, and 48 months of follow-up and the groups were described according to use of ICS, long-acting β2-agonists (LABA), and long-acting anticholinergics (LAMA), and combinations thereof.

RESULTS: We identified 29,010 COPD exacerbators during 2011-2012. Upon inclusion, 70% received ICS-containing regimens, in combination with LABA (23%) or both LABA and LAMA (41%). The proportion of prevalent users of ICS-containing regimens decreased to 56% during follow-up among exacerbation-free individuals, while it increased to 86% in individuals who experienced at least one exacerbation annually. Persistence to ICS-containing regimens was 58% after 4 years in individuals without exacerbations compared to 74% among those with annual exacerbations. Similar patterns were observed for triple therapy which was the most extensively used drug combination regardless of consistency of exacerbation occurrence.

CONCLUSIONS: The extensive use of ICS and the relatively high persistence to ICS-containing regimens in individuals who had a decrease in exacerbation occurrence highlight a need for the development and implementation of de-escalation strategies in clinical practice.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Clinical Pharmacology
Vol/bind75
Udgave nummer7
Sider (fra-til)1025-1032
ISSN0031-6970
DOI
StatusUdgivet - jul. 2019

Fingeraftryk

Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Drug Utilization
Cholinergic Antagonists
Drug Combinations
Registries
Health
Population

Citer dette

@article{a74070b9c3f743fa8a0f21bc00de653e,
title = "Discontinuation of therapy among COPD patients who experience an improvement in exacerbation status",
abstract = "PURPOSE: A subset of patients with chronic obstructive pulmonary disease (COPD) experience a decrease in exacerbation frequency, leading to a diminished need for treatment with inhaled corticosteroids (ICS). We investigated prescribing and discontinuation patterns of long-acting bronchodilators and ICS in COPD patients according to exacerbation frequency.METHODS: Using the nationwide Danish health registries, we conducted a drug utilization study among patients who had at least two exacerbations or one hospitalization due to an exacerbation during 2011-2012. This study population was stratified according to consistency of exacerbation occurrence after 12, 24, 36, and 48 months of follow-up and the groups were described according to use of ICS, long-acting β2-agonists (LABA), and long-acting anticholinergics (LAMA), and combinations thereof.RESULTS: We identified 29,010 COPD exacerbators during 2011-2012. Upon inclusion, 70{\%} received ICS-containing regimens, in combination with LABA (23{\%}) or both LABA and LAMA (41{\%}). The proportion of prevalent users of ICS-containing regimens decreased to 56{\%} during follow-up among exacerbation-free individuals, while it increased to 86{\%} in individuals who experienced at least one exacerbation annually. Persistence to ICS-containing regimens was 58{\%} after 4 years in individuals without exacerbations compared to 74{\%} among those with annual exacerbations. Similar patterns were observed for triple therapy which was the most extensively used drug combination regardless of consistency of exacerbation occurrence.CONCLUSIONS: The extensive use of ICS and the relatively high persistence to ICS-containing regimens in individuals who had a decrease in exacerbation occurrence highlight a need for the development and implementation of de-escalation strategies in clinical practice.",
keywords = "COPD, Inhaled corticosteroids, Long-acting bronchodilators, Pharmacoepidemiology, Utilization patterns",
author = "Mette Reilev and Kristensen, {Kasper Bruun} and Jens S{\o}ndergaard and Henriksen, {Daniel Pilsgaard} and Wade Thompson and Anton Potteg{\aa}rd",
year = "2019",
month = "7",
doi = "10.1007/s00228-019-02667-4",
language = "English",
volume = "75",
pages = "1025--1032",
journal = "European Journal of Clinical Pharmacology",
issn = "0031-6970",
publisher = "Heinemann",
number = "7",

}

TY - JOUR

T1 - Discontinuation of therapy among COPD patients who experience an improvement in exacerbation status

AU - Reilev, Mette

AU - Kristensen, Kasper Bruun

AU - Søndergaard, Jens

AU - Henriksen, Daniel Pilsgaard

AU - Thompson, Wade

AU - Pottegård, Anton

PY - 2019/7

Y1 - 2019/7

N2 - PURPOSE: A subset of patients with chronic obstructive pulmonary disease (COPD) experience a decrease in exacerbation frequency, leading to a diminished need for treatment with inhaled corticosteroids (ICS). We investigated prescribing and discontinuation patterns of long-acting bronchodilators and ICS in COPD patients according to exacerbation frequency.METHODS: Using the nationwide Danish health registries, we conducted a drug utilization study among patients who had at least two exacerbations or one hospitalization due to an exacerbation during 2011-2012. This study population was stratified according to consistency of exacerbation occurrence after 12, 24, 36, and 48 months of follow-up and the groups were described according to use of ICS, long-acting β2-agonists (LABA), and long-acting anticholinergics (LAMA), and combinations thereof.RESULTS: We identified 29,010 COPD exacerbators during 2011-2012. Upon inclusion, 70% received ICS-containing regimens, in combination with LABA (23%) or both LABA and LAMA (41%). The proportion of prevalent users of ICS-containing regimens decreased to 56% during follow-up among exacerbation-free individuals, while it increased to 86% in individuals who experienced at least one exacerbation annually. Persistence to ICS-containing regimens was 58% after 4 years in individuals without exacerbations compared to 74% among those with annual exacerbations. Similar patterns were observed for triple therapy which was the most extensively used drug combination regardless of consistency of exacerbation occurrence.CONCLUSIONS: The extensive use of ICS and the relatively high persistence to ICS-containing regimens in individuals who had a decrease in exacerbation occurrence highlight a need for the development and implementation of de-escalation strategies in clinical practice.

AB - PURPOSE: A subset of patients with chronic obstructive pulmonary disease (COPD) experience a decrease in exacerbation frequency, leading to a diminished need for treatment with inhaled corticosteroids (ICS). We investigated prescribing and discontinuation patterns of long-acting bronchodilators and ICS in COPD patients according to exacerbation frequency.METHODS: Using the nationwide Danish health registries, we conducted a drug utilization study among patients who had at least two exacerbations or one hospitalization due to an exacerbation during 2011-2012. This study population was stratified according to consistency of exacerbation occurrence after 12, 24, 36, and 48 months of follow-up and the groups were described according to use of ICS, long-acting β2-agonists (LABA), and long-acting anticholinergics (LAMA), and combinations thereof.RESULTS: We identified 29,010 COPD exacerbators during 2011-2012. Upon inclusion, 70% received ICS-containing regimens, in combination with LABA (23%) or both LABA and LAMA (41%). The proportion of prevalent users of ICS-containing regimens decreased to 56% during follow-up among exacerbation-free individuals, while it increased to 86% in individuals who experienced at least one exacerbation annually. Persistence to ICS-containing regimens was 58% after 4 years in individuals without exacerbations compared to 74% among those with annual exacerbations. Similar patterns were observed for triple therapy which was the most extensively used drug combination regardless of consistency of exacerbation occurrence.CONCLUSIONS: The extensive use of ICS and the relatively high persistence to ICS-containing regimens in individuals who had a decrease in exacerbation occurrence highlight a need for the development and implementation of de-escalation strategies in clinical practice.

KW - COPD

KW - Inhaled corticosteroids

KW - Long-acting bronchodilators

KW - Pharmacoepidemiology

KW - Utilization patterns

U2 - 10.1007/s00228-019-02667-4

DO - 10.1007/s00228-019-02667-4

M3 - Journal article

VL - 75

SP - 1025

EP - 1032

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

SN - 0031-6970

IS - 7

ER -