Abstract
IntroductionMany patients with chronic obstructive pulmonary disease (COPD) prescribed long-acting muscarinic antagonist (LAMA) monotherapy remain symptomatic. This multivariable analysis of a previously reported claims-linked, cross-sectional survey assessed symptom burden measured by the COPD assessment test (CAT) in patients treated with LAMA monotherapy.MethodsEligible patients aged ≥ 40 years with COPD (≥ 2 International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] diagnosis codes ≥ 30 days apart during the 12-month baseline period) and ≥ 2 claims for LAMA monotherapy in the latter half of the baseline period were identified using claims data from the Optum Research Database. Patients completed a survey and 7-day daily diary; baseline clinical characteristics and resource utilization were assessed from claims data. Association between symptom burden and baseline characteristics was assessed using generalized linear regression modeling with normal distribution and identity link.ResultsOverall, 433 patients prescribed LAMA monotherapy with claims-linked survey and diary data were included in the analysis. Most patients (85.5%) had a mean CAT score ≥ 10; 39.0% had scores ≥ 21. Overall, the factors most related to a clinically meaningful increase in CAT score (≥ 2 points) were being diagnosed with COPD for > 5 years and being a current smoker (2.25 points, P = 0.003 and 2.22 points, P = 0.025, respectively).ConclusionsResults demonstrate that many patients with COPD receiving LAMA monotherapy remain symptomatic, especially those diagnosed > 5 years ago or those who continue to smoke. Use of patient-reported outcomes such as the CAT should be considered part of routine visits for patients with COPD.FundingGlaxoSmithKline (GSK study number 205862 [HO-16-16642]).Electronic supplementary materialThe online version of this article (10.1007/s41030-019-00098-1) contains supplementary material, which is available to authorized users.
Highlights
Many patients with chronic obstructive pulmonary disease (COPD) prescribed long-acting muscarinic antagonist (LAMA) monotherapy remain symptomatic
Patients with a long history of Chronic obstructive pulmonary disease (COPD) diagnosis and who are current smokers were predicted to have a higher symptom burden as shown by an increase in COPD assessment test (CAT) score of C 2 points, which is the estimated minimal clinically important difference (MCID) [15]. This may be a reflection of disease progression and/or indicate that these patients may benefit from additional therapeutic intervention
This may be due to factors that were not observed in this study, such as the time between the last exacerbation and patient survey
Summary
Many patients with chronic obstructive pulmonary disease (COPD) prescribed long-acting muscarinic antagonist (LAMA) monotherapy remain symptomatic. This multivariable analysis of a previously reported claims-linked, cross-sectional survey assessed symptom burden measured by the COPD assessment test (CAT) in patients treated with LAMA monotherapy. A recent claims-linked survey study of a US population of patients with COPD receiving LAMA monotherapy found that 71.6% remained symptomatic based on C 2 COPD-related patient-reported burden of illness measures. For these patients, escalation to LAMA/LABA combination therapy is recommended, with escalation to triple therapy (a combination of a LAMA, LABA, and inhaled corticosteroids [8]) if symptoms persist or if patients are at high risk for a COPD exacerbation [6]
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