DESCRIPTION OF EXACERBATION HISTORY PRIOR TO INITIAL MAINTENANCE THERAPY AMONG PATIENTS WITH COPD IN THE UNITED STATES

Abstract

SESSION TITLE: Monday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: To describe exacerbation history prior to initiating maintenance therapy (IMT) among patients with chronic obstructive pulmonary disease (COPD) to elucidate current IMT prescribing practices. METHODS: This retrospective observational study used a US health insurer claims database (Optum Clinformatics Data) of commercial and Medicare advantage enrollees. Patients with a first claim (index) for inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), or long-acting β2-agonist (LABA) mono/combination therapy during Oct 1, 2017 to Sep 30, 2018, aged ≥40 years, continuously enrolled for ≥12 months pre-index, and with ≥1 COPD diagnosis code were identified. Exclusion criteria included an asthma diagnosis or ICS-, LABA-, or LAMA-containing therapy claims in the 12-month pre-index period, or an asthma diagnosis at index. Exacerbations (moderate: COPD-related outpatient/emergency department visit and a systemic-corticosteroid/antibiotics claim; severe: COPD-related hospitalization), time from last exacerbation to IMT, and clinical characteristics were assessed for the 12-month pre-index period, including index. Demographics and IMT drug class were assessed at index. Results by exacerbation status in the pre-index period were also reported. RESULTS: The 42,957 eligible patients had a mean (standard deviation [SD]) age and Charlson Comorbidity Index (CCI) of 70.5 (10.0) years and 2.9 (2.2), respectively; 52.5% were female and 83.6% were Medicare enrollees. There were 14,905 (34.7%) patients who experienced ≥1 moderate (26.6%) or severe (5.7%) exacerbation, or both (2.4%). Exacerbating patients had a mean (SD) age and CCI of 70.2 (10.0) years and 2.9 (2.2), respectively; 55.7% were female and 83.2% were Medicare enrollees. The most common IMTs for exacerbating patients were ICS/LABA (47.5%), LAMA (16.7%), and LAMA/LABA (16.1%), with 7.0% receiving ICS/LAMA/LABA. Mean (SD) time from last exacerbation to IMT initiation was 88.1 (104.2) days, with the highest proportion (38.3%) of patients having their first IMT fill within 15 days of an exacerbation. For non-exacerbating patients (65.3%), mean (SD) age and CCI were 70.6 (10.0) years and 2.9 (2.2), respectively; 50.8% were female, 83.8% were Medicare enrollees; the most common IMTs were ICS/LABA (44.6%), LAMA (19.8%), and LAMA/LABA (19.2%), with 4.7% receiving ICS/LAMA/LABA. CONCLUSIONS: Only a third of patients had a moderate/severe exacerbation during the 12 months before IMT. ICS/LABA was the most commonly prescribed IMT in non-exacerbating patients. CLINICAL IMPLICATIONS: Improving clinical awareness of ICS-free IMT (LAMA or LAMA/LABA) for non-exacerbating patients is needed as the Global Initiative for Chronic Obstructive Lung Disease 2019 strategy document recommends IMT with LAMA or LAMA/LABA versus ICS/LABA in patients with severe breathlessness. DISCLOSURES: Employee relationship with GSK Please note: $20001 - $100000 Added 03/11/2019 by Chad Moretz, source=Web Response, value=and stocks/shares in GS Removed 03/11/2019 by Chad Moretz, source=Web Response Employee relationship with GSK Please note: $20001 - $100000 Added 03/11/2019 by Chad Moretz, source=Web Response, value=Salary & stocks/shares Employee relationship with GlaxoSmithKline Please note: >$100000 Added 03/11/2019 by Riju Ray, source=Web Response, value=Salary Employee relationship with Glaxosmithkline Please note: >$100000 Added 03/11/2019 by Qin Shen, source=Web Response, value=Salary hold stocks relationship with Glaxosmithkline Please note: $20001 - $100000 Added 03/11/2019 by Qin Shen, source=Web Response, value=stocks Employee relationship with GlaxoSmithkline Please note: >$100000 Added 03/12/2019 by Richard Stanford, source=Web Response, value=Salary