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Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain.
- Source :
-
International journal of chronic obstructive pulmonary disease [Int J Chron Obstruct Pulmon Dis] 2022 Sep 07; Vol. 17, pp. 2161-2174. Date of Electronic Publication: 2022 Sep 07 (Print Publication: 2022). - Publication Year :
- 2022
-
Abstract
- Purpose: To determine the clinical and economic impact of inhaled corticosteroid (ICS) withdrawal in Spanish patients with COPD receiving triple therapy (TT) with ICS, long-acting β <subscript>2</subscript> -agonist (LABA), and long-acting muscarinic antagonist (LAMA).<br />Patients and Methods: This was an observational, retrospective study of BIG-PAC database medical records. Patients aged ≥40 years receiving TT from 2016 to 2018 were followed for 1 year. Two cohorts were identified: patients continuing TT (ICS+LABA+LAMA), and patients receiving TT with ICS withdrawn (LABA+LAMA). Variables included medication, exacerbations (moderate and severe), pneumonia, mortality, health resource use (HRU), and cost per patient/year. Cohorts were compared using propensity score matching (PSM). Multivariate statistical analysis using analysis of covariance and Cox proportional risks was conducted.<br />Results: Of 6541 patients included, 5740 (87.8%) continued TT and 801 (12.2%) had ICS withdrawn. Patients with ICS withdrawal were younger, had lower disease burden, higher ICS doses, and more exacerbations compared with those continuing ICS. PSM matched 795 patients in each cohort. Mean age was 68.5 years (SD: 11.2), 69.9% were male, and mean Charlson index was 2.0. Patients with ICS withdrawal had more total exacerbations in the 12 months following withdrawal compared with patients continuing TT (36.6% vs 31.4%; p=0.030). No significant differences were found for pneumonia (3.3% vs 3.6%; p=0.583) and mortality (9.9% vs 7.5%; p=0.092). Median time to first exacerbation was shorter in patients with ICS withdrawal compared with those continuing ICS (HR: 0.69, 95% CI: 0.57-0.83; p<0.001). Mean health cost per patient/year among patients with ICS withdrawal was higher than those continuing TT (€2993 vs €2130; p<0.001).<br />Conclusion: ICS withdrawal in patients with COPD receiving TT was associated with increased exacerbations, HRU, and costs compared with continuing TT, with health and economic impacts on patients and the Spanish National Healthcare System, respectively. Pneumonia and mortality rates were similar between groups.<br />Competing Interests: VNG, LAV-A, ASI, RC, SS, and MG-P are employees of GlaxoSmithKline; LAV-A and ASI also hold stocks in GlaxoSmithKline. AS-M and AS-N are employees of Real Life Data. Real Life Data received payments from GlaxoSmithKline to perform the study, but not for manuscript development. CG received fees from GlaxoSmithKline for her involvement in the study, but not for manuscript development. The authors report no other conflicts of interest in this work.<br /> (© 2022 Neches García et al.)
- Subjects :
- Administration, Inhalation
Adrenal Cortex Hormones
Adrenergic beta-2 Receptor Agonists
Aged
Bronchodilator Agents
Female
Humans
Male
Muscarinic Antagonists
Retrospective Studies
Spain
Pneumonia chemically induced
Pneumonia complications
Pneumonia diagnosis
Pulmonary Disease, Chronic Obstructive complications
Pulmonary Disease, Chronic Obstructive diagnosis
Pulmonary Disease, Chronic Obstructive drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1178-2005
- Volume :
- 17
- Database :
- MEDLINE
- Journal :
- International journal of chronic obstructive pulmonary disease
- Publication Type :
- Academic Journal
- Accession number :
- 36101793
- Full Text :
- https://doi.org/10.2147/COPD.S367708