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Presented at the American Thoracic Society Annual Meeting, Virtual, May 14–19, 2021 Objectives Jeronimo Espinosa 1 , Thiago Nogueira 2 , Claudia Soares 2 , Gabriela Abreu 2 , Felipe Moraes dos Santos 3 , Juan Criniti 1 , Alejandro Raimondi 1 , Rosana Felice 1 , Valeria Beruto 4 , Paula Scibona 4 , Waldo Belloso 4 , Nadia Savoy 4 , Gabriela Alejandra Blugerman 5 , Graciela Svetliza 6 , Esteban Wainstein 6 , Hernán Talamoni 7 , Néstor Pisapia 7 Results Rationale Characteristics of COPD patients before first controller therapy from Hospital Italiano, Argentina 1 GlaxoSmithKline, Buenos Aires, Argentina; 2 GlaxoSmithKline, Rio de Janeiro, RJ, Brazil; 3 GlaxoSmithKline, Santiago, Chile; 4 Clinical Pharmacology Section, Hospital Italiano de Buenos Aires, Argentina; 5 Research Department, Hospital Italiano de Buenos Aires, Argentina; 6 Adult Pulmonology Section, Hospital Italiano de Buenos Aires, Argentina; 7 Pediatric Pulmonology Section, Hospital Italiano de Buenos Aires, Argentina • Describe the characteristics of COPD patients undergoing first COPD controller therapy • Evaluate the first COPD controller treatment used in a health maintenance organization (HMO) in Buenos Aires, Argentina. Disclosures • This study was funded by GlaxoSmithKline (GSK study PRJ2763). • CS, JC, JE, RF and AR are GlaxoSmithKline employees and hold stocks; FM is a GlaxoSmithKline employee; GA and TN are complementary workers at GlaxoSmithKline; VB, PS, NS, GAB, GS, EW, WB, HT, NP are employees of Hospital Italiano de Buenos Aires, Buenos Aires; Hospital Italiano de Buenos Aires received funding from GlaxoSmithKline to conduct the study. • On behalf of all authors, an audio recording of this poster was prepared Jeronimo Espinosa, who did not receive any payment for this recording. Some chronic obstructive pulmonary disease (COPD) patients are not adequately controlled and are at risk of future exacerbations that could significantly deteriorate patient health. Identifying COPD patients most at risk is key to implementing an earlier and optimized treatment approach. Acknowledgements Editorial support (in the form of writing assistance, including preparation of the draft poster under the direction and guidance of the authors, collating and incorporating authors’ comments for each draft, assembling tables and figures, grammatical editing and referencing) was provided by Tony Reardon, at Aura (a division of Spirit Medical Communications Ltd), and was funded by GSK. Scan the QR code or go to https://tago.ca/-ATS14 to access a downloadable version of this presentation Methods Electronic medical records Pharmacy dispensing data Retrospective cohort study Data sources Study design Study population COPD patients Aged ≥35 years Study dates 01 Jan 2007– 31 Dec 2018 Timeframe 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2 complete years follow-up Incomplete follow-up period Baseline period (1 year before index date) Index date: 1st dispensed controller End of patient follow-up Lost to follow-up First COPD health problem registered Index date Date first controller dispensed (inhaled corticosteroid [ICS], long-acting β2 agonist [LABA], or long-acting muscarinic antagonist [LAMA], and combinations) Study start Study end Baseline: 1 year before index date Follow-up: 2 years after index date Conclusions n=2424 COPD patients 49.5% n=1199 50.5% n=1225 Mean age: 72.5 years (standard deviation 9.9) Nutritional status Most common comorbidities before or at index date Depression n=536 22.1% Asthma n=452 18.7% Hypertension n=1586 65.4% Myocardial infarction n=339 14.0% No moderate or severe exacerbation (69.6%) 1 (21.7%) 2 (4.9%) 3 (1.9%) ≥4 (2.0%) Number of moderate or severe exacerbations* (% patients) 87.1 8.5 2.5 0.7 1.2 0 20 40 60 80 100 0 1 2 3 ≥4 exacerbations Proportion of patients with moderate exacerbations Proportion of patients with severe exacerbations % patients 79.0 17.7 2.5 0.7 0.1 0 20 40 60 80 100 0 1 2 3 ≥4 exacerbations % patients 12.9% of patients had ≥1 moderate exacerbation at baseline 21.0% of patients had ≥1 severe exacerbation at baseline Figure 1. Proportion of patients with exacerbations at baseline (i.e. the 12 months prior to index date) 30.5% of patients had ≥1 exacerbation at baseline No moderate or severe exacerbation (69.5%) 10.9 6.6 3.5 4.4 0.6 1.2 9.9 10.6 6.3 13.1 21.0 26.9 80.4 74.7 60.4 54.6 0.0 0.2 0.2 0.3 0.0 0.0 0.8 0.5 1.8 4.2 4.2 2.7 0 10 20 30 40 50 60 70 80 90 100 2007 - 2009 2010 - 2012 2013 - 2015 2016 - 2018 % patients Triennium ICS LABA LAMA ICS+LABA ICS+LAMA LABA+LAMA ICS+LABA+LAMA COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting β2 agonist; LAMA, long-acting muscarinic antagonist. Use of LABA over time Use of LAMA over time Use of ICS+LABA over time Figure 2. Frequency of first controller use per trienniums 2007–2009, 2010–2012, 2013–15, 2016–2018 in COPD patients from Hospital Italiano, Argentina ICS 6.9% LABA 4.9% LAMA 15.1% ICS+LABA, 69.6% ICS+LAMA, 0.1% LABA+LAMA, 0.3% ICS +LABA +LAMA 0 10 20 30 40 50 60 70 80 90 100 Triple therapy Dual therapy Mono-therapy % patients First controller 26.9% (n=650) 70.0% (n=1,698) 3.1% (n=76) ICS, inhaled corticosteroid; LABA, long-acting β2 agonist; LAMA, long-acting muscarinic antagonist. Dual and triple therapy can be both single and multiple inhalers Figure 3. Therapeutic class combination of the first controller use Median time from diagnosis until first controller use: 6 months The decrease of ICS+LABA as a first controller of COPD patients’ treatment through the trienniums was linked to the launch of new controllers such as new LAMAs, used as monotherapy or in combination with other drugs prescribed for COPD. Almost one third of COPD patients in this HMO experienced exacerbations, and were at high risk of future exacerbations, highlighting an addressable unmet need for treatment optimization. 37.4% (n=869) Overweight (BMI 25.0-29.9 kg/m 2 ) 29.6% (n=689) Obese (BMI ≥30 kg/m 2 ) *Moderate, requiring systemic corticoid/antibiotic use; Severe, requiring Emergency Room visit/hospitalization
