Real-world treatment trajectories of adults with newly diagnosed asthma or COPD.

Background: There is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice.
Methods: This retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots.
Results: In four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%-47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%-33.2% for asthma and 27.0%-52.2% for COPD) from the USA as compared with EHR databases (6.9%-15.2% for asthma and 4.4%-17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments.
Conclusion: Real-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients' needs.
Competing Interests: Competing interests: AFM, PRR, JAK and KMV work for a department that receives/received unconditional research grants from Amgen, Chiesi, Johnson and Johnson, UCB Biopharma, the European Medicines Agency and the Innovative Medicines Initiative. DP-A’s department has received grants from Amgen, Chiesi-Taylor, Lilly, Johnson and Johnson, Novartis, UCB Biopharma, the European Medicines Agency, and the Innovative Medicines Initiative. DP-A’s research group has received consultancy fees from Astra Zeneca and UCB Biopharma. DP-A’s department has organised training programmes funded or supported by Amgen, Astellas, Johnson and Johnson, Synapse Management Partners, and UCB Biopharma. JK’s institute has received grants from the American Lung Association, COPD Foundation, National Heart Lung and Blood institute, PCORI, Regeneron, Sergey Brin Family Foundation and US National Institutes of Health. JK has received consultancy fees from AstraZeneca, BData and GlaxoSmithKline. JK has received honoraria from University of Chicago, University of Washington/VA Puget Sound and travel support from the Global Initiative for Asthma, American Thoracic Society. GBB’s institute has received grants from Merck Sharp & Dohme. GBB has received honoraria from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Sanofi. All other authors declare no competing interests.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)