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The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK

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Abstract
Background: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT. Methods: This was a historical analysis of COPD patients without asthma from the Optimum Patient Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. Patient disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after COPD diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council dyspnea score, and exacerbation history on the pathway to TT. Results: During the study period, 32% of patients received TT. Of these, 19%, 28%, 37%, and 46% of patients classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P,0.001). Of all patients prescribed TT, 25% were prescribed TT within 1 year of diagnosis, irrespective of GOLD classification (P=0.065). The most common prescription pathway to TT was LABA plus ICS. It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT. Conclusion: Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of COPD guidelines to physicians, ensuring that patients receive the recommended therapy.
Keywords
prescribing patterns, chronic obstructive pulmonary disease, observational study, primary care, GOLD guidelines, OBSTRUCTIVE PULMONARY-DISEASE, BLOOD EOSINOPHIL COUNTS, INHALED CORTICOSTEROIDS, REAL-LIFE, CLINICAL-PRACTICE, MODERATE COPD, RISK, GUIDELINES, EXACERBATIONS, FLUTICASONE

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MLA
Brusselle, Guy et al. “The Inevitable Drift to Triple Therapy in COPD: An Analysis of Prescribing Pathways in the UK.” INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE 10 (2015): 2207–2217. Print.
APA
Brusselle, G., Price, D., Gruffydd-Jones, K., Miravitlles, M., Keininger, D. L., Stewart, R., Baldwin, M., et al. (2015). The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK. INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, 10, 2207–2217.
Chicago author-date
Brusselle, Guy, David Price, Kevin Gruffydd-Jones, Marc Miravitlles, Dorothy L Keininger, Rebecca Stewart, Michael Baldwin, and Rupert C Jones. 2015. “The Inevitable Drift to Triple Therapy in COPD: An Analysis of Prescribing Pathways in the UK.” International Journal of Chronic Obstructive Pulmonary Disease 10: 2207–2217.
Chicago author-date (all authors)
Brusselle, Guy, David Price, Kevin Gruffydd-Jones, Marc Miravitlles, Dorothy L Keininger, Rebecca Stewart, Michael Baldwin, and Rupert C Jones. 2015. “The Inevitable Drift to Triple Therapy in COPD: An Analysis of Prescribing Pathways in the UK.” International Journal of Chronic Obstructive Pulmonary Disease 10: 2207–2217.
Vancouver
1.
Brusselle G, Price D, Gruffydd-Jones K, Miravitlles M, Keininger DL, Stewart R, et al. The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK. INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. 2015;10:2207–17.
IEEE
[1]
G. Brusselle et al., “The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK,” INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, vol. 10, pp. 2207–2217, 2015.
@article{6965157,
  abstract     = {Background: Real-world prescription pathways leading to triple therapy (TT) (inhaled corticosteroid [ICS] plus long-acting β2-agonist bronchodilator [LABA] plus long-acting muscarinic antagonist) differ from Global initiative for chronic Obstructive Lung Disease [GOLD] and National Institute for Health and Care Excellence treatment recommendations. This study sets out to identify COPD patients without asthma receiving TT, and determine the pathways taken from diagnosis to the first prescription of TT.
Methods: This was a historical analysis of COPD patients without asthma from the Optimum Patient Care Research Database (387 primary-care practices across the UK) from 2002 to 2010. Patient disease severity was classified using GOLD 2013 criteria. Data were analyzed to determine prescribing of TT before, at, and after COPD diagnosis; the average time taken to receive TT; and the impact of lung function grade, modified Medical Research Council dyspnea score, and exacerbation history on the pathway to TT.
Results: During the study period, 32% of patients received TT. Of these, 19%, 28%, 37%, and 46% of patients classified as GOLD A, B, C, and D, respectively, progressed to TT after diagnosis (P,0.001). Of all patients prescribed TT, 25% were prescribed TT within 1 year of diagnosis, irrespective of GOLD classification (P=0.065). The most common prescription pathway to TT was LABA plus ICS. It was observed that exacerbation history did influence the pathway of LABA plus ICS to TT.
Conclusion: Real life UK prescription data demonstrates the inappropriate prescribing of TT and confirms that starting patients on ICS plus LABA results in the inevitable drift to overuse of TT. This study highlights the need for dissemination and implementation of COPD guidelines to physicians, ensuring that patients receive the recommended therapy.},
  author       = {Brusselle, Guy and Price, David and Gruffydd-Jones, Kevin and Miravitlles, Marc and Keininger, Dorothy L and Stewart, Rebecca and Baldwin, Michael and Jones, Rupert C},
  issn         = {1178-2005},
  journal      = {INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE},
  keywords     = {prescribing patterns,chronic obstructive pulmonary disease,observational study,primary care,GOLD guidelines,OBSTRUCTIVE PULMONARY-DISEASE,BLOOD EOSINOPHIL COUNTS,INHALED CORTICOSTEROIDS,REAL-LIFE,CLINICAL-PRACTICE,MODERATE COPD,RISK,GUIDELINES,EXACERBATIONS,FLUTICASONE},
  language     = {eng},
  pages        = {2207--2217},
  title        = {The inevitable drift to triple therapy in COPD: an analysis of prescribing pathways in the UK},
  url          = {http://dx.doi.org/10.2147/COPD.S91694},
  volume       = {10},
  year         = {2015},
}

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