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. 2021 Apr 20:16:1075-1091.
doi: 10.2147/COPD.S290887. eCollection 2021.

Long-Acting Bronchodilator Use in Chronic Obstructive Pulmonary Disease in Primary Care in New Zealand: A Retrospective Study of Treatment Patterns and Evolution Using the HealthStat Database

Dominique Milea  1 , See-Hwee Yeo  1 , Yein Nam  2 , Aldo Amador Navarro Rojas  1 , Sumitra Shantakumar  1 , Janine Beale  3 , Brett Marett  3 , Robert P Young  4 , Raewyn J Scott  4 , Barry Gribben  5
Affiliations

Long-Acting Bronchodilator Use in Chronic Obstructive Pulmonary Disease in Primary Care in New Zealand: A Retrospective Study of Treatment Patterns and Evolution Using the HealthStat Database

Dominique Milea et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Long-acting bronchodilator (LABD) use is the mainstay of pharmacologic treatment for chronic obstructive pulmonary disease (COPD). Few studies describe evolving patterns of LABD use in the setting of changing inhaler availability and updated clinical guidelines.

Methods: A retrospective cohort study in New Zealand using the HealthStat general practice database (01/2014 to 04/2018). Eligible patients (aged ≥40 years) had COPD and ≥1 LABD prescription (long-acting muscarinic antagonist [LAMA] and/or long-acting β2-agonist [LABA]) during the index period (05/2015 to 04/2016). Demographics and clinical characteristics of all LABD users (overall/by treatment) were described at baseline. Patients starting LABD treatment during the index period, termed "new" users, were also described, as was their treatment evolution over 24 months of follow-up. Yearly LABD initiation rates were assessed from 2015 to 2017, covering changes to Pharmaceutical Management Agency criteria and clinical guidelines.

Results: Across 2140 eligible patients, the most common index treatments were inhaled corticosteroid (ICS)/LABA (59.0%) and open triple therapy (LAMA+LABA+ICS; 26.7%). ICS/LABA therapy was highest in younger patients, with open triple therapy highest in older patients. Prior yearly exacerbation rates were lowest in those receiving monotherapy (LABA: 0.9/year; LAMA: 1.1/year) versus dual therapy (all 1.4/year) and open triple therapy (2.2/year). Of 312 new LABD users, ICS/LABA was the most common index treatment (69.6%), followed by LAMA monotherapy (16.0%). Continuous use with index treatment was 31.1% at 12 months and 13.5% at 24 months; mean time to treatment change was 175.5 and 244.1 days, respectively. Among patients modifying treatment at 24 months, 23.0% augmented, 7.0% switched, 45.6% re-started, and 24.4% discontinued/stepped down. Among patients initiating LABD each year from 2015 to 2017, LAMA prescription increased (17% to 46%) while ICS prescription remained stable (approximately 20%).

Conclusion: Predominant use of ICS/LABA (05/2015 to 04/2016) reflects available LABDs and previous restrictions on LAMA use in New Zealand.

Keywords: New Zealand; bronchodilator therapy; chronic obstructive pulmonary disease; inhaled corticosteroid; long-acting muscarinic antagonist; long-acting β2-agonist.

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Conflict of interest statement

DM, AANR, SS, and BM are employees of, and shareholders in, GlaxoSmithKline plc. S-HY and JB are former employees of GlaxoSmithKline plc. YN is a former employee of Adelphi Real World, who received funding from GlaxoSmithKline plc. to conduct this study. RPY and RJS have received honorarium from GlaxoSmithKline plc. for educational talks and participation in advisory groups. BG is an employee of CBG Health Research Ltd, who received funding from GlaxoSmithKline plc. to conduct this study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study design, showing the observation and index periods for the main cohort of all LABD users (A); the sub-cohort of new LABD users (B); and the additional analysis of yearly rates of LABD initiation (C).
Figure 2
Figure 2
Patient disposition for all LABD users.
Figure 3
Figure 3
LABD treatment for all LABD users, stratified by patient age at index (A) and ethnicity (B).
Figure 4
Figure 4
Patient exacerbation history at index for all LABD users, stratified by type of LABD treatment.
Figure 5
Figure 5
LABD treatment in new LABD users, stratified by patient age at index.
Figure 6
Figure 6
Yearly rates of LABD initiation from 2015 to 2017.
See this image and copyright information in PMC

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Grants and funding

This work was funded by GlaxoSmithKline plc. (study 209016).