COPD EXACERBATION RATE BY BASELINE COPD ASSESSMENT TEST SCORE IN THE DYNAGITO STUDY

Abstract

SESSION TITLE: Wednesday Electronic Posters 3 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document defines patients with symptomatic chronic obstructive pulmonary disease (COPD) as those with a COPD Assessment Test (CAT) score cut-off of 10. We investigated whether baseline CAT score predicted the rate of exacerbations treated with antibiotics, systemic corticosteroids or both in patients with a history of exacerbations in the DYNAGITO study. METHODS: DYNAGITO was a 52-week, double-blind, randomized clinical trial in patients with COPD with forced expiratory volume in 1 second <60% predicted and at least 1 moderate-to-severe exacerbation in the previous year (NCT02296138). Patients received tiotropium/olodaterol 5/5 µg or tiotropium 5 µg once daily. In this post hoc analysis, we have pooled the treatment arms. A negative binomial model adjusted for treatment, baseline smoking status, inhaled corticosteroid use at screening, GOLD stage, region and exacerbation history was used to analyze exacerbation rate. RESULTS: At baseline, 920 patients were categorized with CAT score 0–9, 3,810 with 10–20, 2,681 with 21–30 and 442 with 31–40. Patients with a history of ≥2 exacerbations in the previous year had higher CAT scores at baseline (46.6% CAT 21–40) than patients with 0 or 1 exacerbation in the previous year (37.1% CAT 21–40). The adjusted rate of moderate-to-severe exacerbations was higher in patients with a higher CAT score at baseline (0.93 and 0.96 per patient-year in patients with CAT 21–30 and 31–40, respectively) than in those with a lower CAT score (0.62 and 0.79 in patients with CAT 0–9 and 10–20, respectively; P<0.05 for all comparisons except 21 -30 versus 31 -40). The rate of exacerbations treated with both corticosteroids and antibiotics rose with increasing CAT score: 0.29, 0.38, 0.49 and 0.52 per patient-year for CAT 0 -9, 10 -20, 21 -30 and 31 -40, respectively. The rate of exacerbations treated with antibiotics only was similar across CAT subgroups (0.24 -0.25 per patient-year), and events treated with corticosteroids alone were less frequent in patients with CAT 0 -9 (0.07 per patient-year), but similar across the other CAT subgroups (0.14 -0.15 per patient-year). CONCLUSIONS: CAT score was higher among patients with 2 or more exacerbations. High baseline CAT score predicted a higher rate of moderate-to-severe exacerbations and a more aggressive treatment of events, demonstrated by a higher rate of exacerbations treated with both corticosteroids and antibiotics. CLINICAL IMPLICATIONS: In patients with a history of exacerbations, symptom burden defined by higher CAT scores was associated with a higher rate of exacerbations, particularly those treated with both corticosteroids and antibiotics, in patients with COPD. DISCLOSURES: Consultant relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/13/2019 by Antonio Anzueto, source=Web Response, value=Consulting fee Removed 03/13/2019 by Antonio Anzueto, source=Web Response Consultant relationship with GlaxoSmithKline Please note: $1001 - $5000 Added 03/13/2019 by Antonio Anzueto, source=Web Response, value=Consulting fee Removed 03/13/2019 by Antonio Anzueto, source=Web Response Consultant relationship with AstraZeneca Please note: $1001 - $5000 Added 03/13/2019 by Antonio Anzueto, source=Web Response, value=Consulting fee+travel Consultant Consultant relationship with GlaxoSmithKline Please note: $1001 - $5000 Added 03/13/2019 by Antonio Anzueto, source=Web Response, value=Consulting fee+travel Consultant relationship with Sunovion Please note: $1001 - $5000 Added 03/13/2019 by Antonio Anzueto, source=Web Response, value=Consulting fee+travel Advisory Committee Member relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/12/2019 by Peter Calverley, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/12/2019 by Peter Calverley, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/12/2019 by Peter Calverley, source=Web Response, value=Travel Advisory Committee Member relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/12/2019 by Peter Calverley, source=Web Response, value=Travel Employee relationship with Boehringer Ingelheim Please note: $20001 - $100000 Added 03/14/2019 by Alberto de la Hoz, source=Web Response, value=Salary Consultant relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/21/2019 by Christine Jenkins, source=Admin input, value=Consulting fee Scientific Medical Advisor relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 03/22/2019 by Klaus Rabe, source=Admin input, value=Consulting fee Scientific Medical Advisor relationship with Takeda Please note: $1001 - $5000 Added 03/22/2019 by Klaus Rabe, source=Admin input, value=Grant/Research Support Scientific Medical Advisor relationship with AstraZeneca Please note: $5001 - $20000 Added 03/22/2019 by Klaus Rabe, source=Admin input, value=Consulting fee Scientific Medical Advisor relationship with Novartis Please note: $5001 - $20000 Added 03/22/2019 by Klaus Rabe, source=Admin input, value=Consulting fee Scientific Medical Advisor relationship with Chiesi Pharmaceuticals Please note: $1001 - $5000 Added 03/22/2019 by Klaus Rabe, source=Admin input, value=Consulting fee Employee relationship with Boehringer Ingelheim Please note: $20001 - $100000 Added 03/13/2019 by Florian Voß, source=Web Response, value=Salary Other relationship with GSK Please note: >$100000 Added 03/12/2019 by Jadwiga Wedzicha, source=Web Response, value=Grant/Research Other relationship with Boehringer Please note: >$100000 Added 03/12/2019 by Jadwiga Wedzicha, source=Web Response, value=Grant/Research Support Other relationship with Astra Zeneca Please note: >$100000 Added 03/12/2019 by Jadwiga Wedzicha, source=Web Response, value=Grant/Research Support Other relationship with Novartis Please note: >$100000 Added 03/12/2019 by Jadwiga Wedzicha, source=Web Response, value=Grant/Research Support Other relationship with Chiesi Please note: >$100000 Added 03/12/2019 by Jadwiga Wedzicha, source=Web Response, value=Grant/Research Support