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Eur J Clin Pharmacol. 2019 Mar 22. doi: 10.1007/s00228-019-02667-4. [Epub ahead of print]

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

Author information

1
Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark. mreilev@health.sdu.dk.
2
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 19, 2, 5000, Odense C, Denmark. mreilev@health.sdu.dk.
3
Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
4
Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 19, 2, 5000, Odense C, Denmark.
5
Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense C, Denmark.

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

PMID:
30903196
DOI:
10.1007/s00228-019-02667-4

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