Clinical Characteristics, Treatment Persistence, and Outcomes Among Patients With COPD Treated With Single- or Multiple-Inhaler Triple Therapy: A Retrospective Analysis in Spain
Clinical Characteristics, Treatment Persistence, and Outcomes Among Patients With COPD Treated With Single- or Multiple-Inhaler Triple Therapy: A Retrospective Analysis in Spain
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DOI：
10.1016/j.chest.2022.06.033
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发表时间：
2022-11-04
期刊：
影响因子：
9.6
通讯作者：
Sicras-Mainar, Antoni
中科院分区：
文献类型：
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作者：
Alcazar-Navarrete, Bernardino;Jamart, Lucia;Sicras-Mainar, Antoni
背景：COPD是死亡和残疾的主要原因。COPD治疗目标包括减少急性加重和改善症状控制。单吸入器三联疗法（SITT）或多吸入器三联疗法（MITT）适用于尽管接受了支气管扩张剂治疗但仍频繁加重的患者。没有证据比较SITT与MITT在西班牙的治疗持久性，急性加重，和其他outcome.RESEARCH QUESTICON：COPD患者在西班牙启动SITT与MITT有改善的持久性，急性加重，和卫生保健资源利用？研究设计和方法：这项真实世界、观察性、回顾性队列研究分析了西班牙国家医疗保健系统BIG-PAC数据库中的电子健康记录，以确定在2018年6月1日至2019年12月31日期间开始SITT或MITT（使用两个或三个吸入器）的年龄≥ 40岁的COPD患者。对12个月随访期间的持续性（允许长达60天无处方续药）、加重率和医疗保健资源利用率和成本进行了比较数据分析。结果：符合条件的患者（N = 4，625）开始SITT（n = 1，011）或MITT（n = 3，614）的平均年龄为70.9岁，大多数是男性（73.9%），主要是中度（62.0%）或重度（26.5%）气流限制。队列间基线特征相似。在12个月随访时，SITT患者的持续性更高，（风险比[HR] = 1.37; 95% CI = 1.22-1.53; P < .001），急性加重风险降低（HR = 0.68; 95% CI = 0.61-0.77; P = 0.001）和较低的全因死亡风险（HR = 0.67; 95% CI = 0.63-0.71，P= 0.027）。SITT与显著减少的卫生保健资源使用相关（平均年成本节约：（原文如此）403 vs MITT）。对于SITT和MITT，与非持续性相比，持续性与改善的急性加重率相关，并且显著调整的平均年成本节省（分别为2，115和2，700）。解释：开始SITT的患者在持续性方面有临床相关的改善，导致死亡率、急性加重发生率和卫生保健资源使用的降低，从而平均成本节省。
BACKGROUND: COPD is a leading cause of death and disability. COPD therapy goals include reducing exacerbations and improving symptom control. Single-inhaler triple therapy (SITT) or multiple-inhaler triple therapy (MITT) is indicated for patients with frequent exacerbations despite bronchodilator therapy. No available evidence compares SITT vs MITT in Spain in terms of treatment persistence, exacerbations, and other outcomes.RESEARCH QUESTICON: COPD patients in Spain initiating SITT vs MITT have improved persistence, exacerbations, and health care resource utilization?STUDY DESIGN AND METHODS: This real-world, observational, retrospective cohort study analyzed electronic health records in the Spanish National Healthcare System BIG-PAC database to identify COPD patients aged >= 40 years initiating SITT or MITT (using two or three inhalers) between June 1, 2018 and December 31, 2019. Comparative data on persistence (allowing up to 60 days without prescription refill), exacerbation rates, and health care resource utilization and costs during 12-month follow-up were analyzed. Multivariate adjusted analyses were performed.RESULTS: Eligible patients (N = 4,625) initiating SITT (n = 1,011) or MITT (n = 3,614) had a mean age of 70.9 years; most were male (73.9%) with mainly moderate (62.0%) or severe (26.5%) airflow limitation. Between-cohort baseline characteristics were similar. At 12-month follow-up, SITT patients had higher persistence (hazard ratio [HR] = 1.37; 95% CI = 1.22-1.53; P < .001), reduced risk of exacerbations (HR = 0.68; 95% CI = 0.61-0.77; P = .001), and lower all-cause mortality risk (HR = 0.67; 95% CI = 0.63-0.71, P= .027), compared with MITT patients. SITT was associated with significantly reduced health care resource use (mean annual cost savings: (sic)403 vs MITT). For both SITT and MITT, persistence was associated with improved exacerbation rates vs nonpersistence, and substantial adjusted mean annual cost savings ((sic)2,115 and (sic)2,700, respectively).INTERPRETATION: Patients initiating SITT had a clinically relevant improvement in persistence leading to reductions in mortality, incidence of exacerbations, and health care resource use with consequent mean cost savings.