PHARMO Institute, PO Box 85222, 3508 AE Utrecht, Utrecht, The Netherlands.
Respir Med. 2011 Feb;105(2):259-65. doi: 10.1016/j.rmed.2010.07.007. Epub 2010 Aug 11.
Long-acting muscarinic antagonists (LAMA), long-acting β2-agonists (LABA) and fixed dose combinations (FDC) of inhaled corticosteroids (ICS) and LABA are used as inhaled maintenance therapies for COPD.
To estimate persistence rates from dispensing patterns of long-acting inhaled drugs for COPD.
From the PHARMO-database, COPD patients starting LAMA, LABA or LABA-ICS FDC between 2002 and 2006 were selected. Persistence with the initial as well as with any long-acting inhaled drug was determined, defined as time between start and stop of initial/any therapy, allowing ≤ 60-days gaps between refills. For patients who did not continue to receive dispensings of the initial therapy for at least one year, the first change in therapy was determined.
The study included 2201 LAMA, 1201 LABA and 4146 LABA-ICS FDC users. Persistence rates with initial therapy alone at 1, 2, and 3 years were 25%, 14%, 8% for LAMA, 21%, 10%, 6% for LABA and 27%, 14%, 8% for LABA-ICS FDC. Of patients who did not persist with LAMA alone for one year, 15% added and 13% switched therapy (both mostly LABA-ICS FDC). Of patients not persisting with LABA alone, 9% added therapy (mostly LAMA) and 31% switched therapy (mostly to LABA-ICS FDC). In patients not persisting with LABA-ICS FDC, add-on and switch occurred equally frequent (11%, mostly LAMA). Persistence rates with any long-acting drug at 1, 2 and 3 years were 36%, 23% and 17% respectively.
Persistence with the initial as well as with any long-acting inhaled drug in COPD is low, with a substantial proportion of patients changing therapy.
长效抗胆碱能药物（LAMA）、长效β2-激动剂（LABA）和吸入皮质类固醇（ICS）和 LABA 的固定剂量组合（FDC）被用作 COPD 的吸入维持治疗。
根据长效吸入药物的配药模式来估计 COPD 的持续率。
从 PHARMO 数据库中，选择 2002 年至 2006 年间开始使用 LAMA、LABA 或 LABA-ICS FDC 的 COPD 患者。确定初始治疗以及任何长效吸入药物的持续性，定义为初始/任何治疗开始和停止之间的时间，允许在补充之间有 ≤60 天的间隔。对于至少一年内未继续接受初始治疗配药的患者，确定第一次治疗改变。
本研究纳入了 2201 名 LAMA、1201 名 LABA 和 4146 名 LABA-ICS FDC 使用者。单独使用初始治疗的 1、2 和 3 年的持续率分别为 25%、14%和 8%，用于 LAMA；21%、10%和 6%，用于 LABA；27%、14%和 8%，用于 LABA-ICS FDC。在未持续使用 LAMA 一年的患者中，15%的患者加用了药物（大多数是 LABA-ICS FDC），13%的患者更换了治疗方案（也是大多数为 LABA-ICS FDC）。在未持续使用 LABA 单独治疗的患者中，9%的患者加用了药物（大多数是 LAMA），31%的患者更换了治疗方案（主要为 LABA-ICS FDC）。在未持续使用 LABA-ICS FDC 的患者中，加用和转换的频率相等（11%，大多数是 LAMA）。任何长效药物的 1、2 和 3 年持续率分别为 36%、23%和 17%。
COPD 患者对初始治疗以及任何长效吸入药物的持续性都很低，有相当一部分患者改变了治疗方案。
