Medication Management Patterns Among Medicare Beneficiaries With COPD Initiating Nebulized Arformoterol Treatment

Abstract

SESSION TITLE: COPD: Lessons for the Real-World Management of Disease SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Global guidelines recommend the use of long-acting bronchodilators (LABD) as maintenance therapy for patients with COPD. However, little is known about the treatment and management patterns associated with initiating nebulized LABD therapy such as arformoterol. This study examined these treatment patterns among Medicare beneficiaries with COPD prior to and after initiating arformoterol. METHODS: Medicare administrative data from 2010-2014 were used to identify beneficiaries with ≥2 COPD outpatient visits within 30 days apart or with ≥1 COPD-related hospitalization(s) (i.e., ICD-9 codes 491.xx, 492.xx, and 496). Patients continuously enrolled in Medicare parts A, B, and D for the entire study period that initiated arformoterol were identified after excluding deaths. The use of the four following COPD medication classes 90-days prior to (pre-period) and after initiation of arformoterol (post-period) were examined: (a) LAMA/LABA: long-acting muscarinic antagonists (LAMAs) and inhaled long-acting beta2 agonists (LABAs) including fixed dose LABA+inhaled corticosteroid (ICS) combinations; (b) ICS/Neb ICS: ICS and nebulized corticosteroids (neb-CS); (c) methylxanthines, and d) other that included medications such as short-acting bronchodilators (SABD), oral corticosteroids and antibiotics. Rates of medication initiation, treatment continuation and discontinuation within these classes were determined based on refill patterns in the post-period. Sociodemographic and clinical characteristics (e.g., comorbidities) were also examined. Descriptive statistics were used to examine means, frequencies, and proportions. All analyses were preformed using SAS Enterprise Guide 7.1. RESULTS: A total of 11,886 nebulized arformoterol users were identified for the analysis. A substantial proportion of the patient cohort was 75 years or older (42%) and dually eligible for Medicaid (37%). Overall, 5,542 (46%) beneficiaries had received no LABD maintenance treatment 90 days prior to initiating arformoterol. Instead, they were being treated with a nebulized (50%) or an inhaled (37%) SABD, a systemic CS (46%), and many were on antibiotics (37%). In the post-period, 58% of beneficiaries received dual-therapy (LABA/ICS/Neb ICS [52%] or LAMA/LAMA [6%]), 21% received triple-therapy (LABA/LAMA/ICS/Neb CS), and 20% received monotherapy (only arformoterol). Nearly 41% of beneficiaries dropped ≥1 classes of medications they were taking prior to initiating arformoterol in the post-period. The largest decrease (-23%) was seen in CS use. CONCLUSIONS: The results suggest that nearly half of beneficiaries with COPD are not being treated with recommended LABD maintenance therapy. Among arformoterol users, dual therapy with a CS was highly prevalent. About 1 in 5 beneficiaries received either triple therapy or monotherapy. CLINICAL IMPLICATIONS: Evaluating the drivers associated with over reliance on SABD in lieu of recommended LABD maintenance treatment for appropriate patients, examining the triggers for initiating arformoterol, and linking arformoterol monotherapy v. combination therapy to outcomes are warranted. These analyses could help advance clinical decision-making for patients with COPD, particularly for those who have a history of exacerbations and hospitalizations. DISCLOSURE: Bartolome Celli: Consultant fee, speaker bureau, advisory committee, etc.: Advance Health Solutions, LLC, University grant monies: Astra Zeneca, Consultant fee, speaker bureau, advisory committee, etc.: Glaxo Smith Kline, Consultant fee, speaker bureau, advisory committee, etc.: Boehringer-Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Astra Zeneca, Consultant fee, speaker bureau, advisory committee, etc.: Novartis, Consultant fee, speaker bureau, advisory committee, etc.: Pulmonix Maryam Navaie: Consultant fee, speaker bureau, advisory committee, etc.: Sunovion Pharmaceuticals Inc., Employee: Advance Health Solutions, LLC Vaidyanathan Ganapathy: Employee: Sunovion Pharmaceuticals, Inc. Zhun Xu: Grant monies (from industry related sources): Advance Health Solutions, LLC Soojin Cho-Reyes: Consultant fee, speaker bureau, advisory committee, etc.: Advance Health Solutions, LLC Todd Gilmer: Grant monies (from industry related sources): Advance Health Solutions, LLC No Product/Research Disclosure Information