Solem Caitlyn T, Lee Todd A, Joo Min J, Lambert Bruce L, Walton Surrey M, Pickard A Simon
Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
Am J Geriatr Pharmacother. 2012 Apr;10(2):110-122.e1. doi: 10.1016/j.amjopharm.2011.12.003. Epub 2012 Jan 26.
To better understand how medications have been used and the complexity of regimens used to treat patients, we characterized patterns of medication use and the degree to which patients used different classes of medications in combination and over time in a cohort of newly diagnosed chronic obstructive pulmonary disease (COPD) patients.
The objectives of this study were to characterize patterns of medication use, including the degree to which patients used different classes of medications in combination and over time within a cohort of newly diagnosed COPD patients and to identify the proportion of patients who had gaps in filling their prescriptions.
We identified a cohort of patients from the Veterans Affairs health care system with newly diagnosed COPD between 1999 and 2003. Using prescription fill information, we quantified the prevalence and incidence of exposure to short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), short-acting anticholinergics (eg, ipratropium [IPRA]), and inhaled corticosteroids (ICSs) over 1 year. We additionally characterized the sequencing of medication addition and discontinuation and gaps between prescription fills. The prevalence of multiple respiratory medication use was summarized at 90, 180, and 365 days of follow-up.
Of 133,737 patients with newly diagnosed COPD, the majority (80.0%) used a SABA, followed by 40.0% using IPRA, 33.2% using an ICS and 16.0% using a LABA during the 1-year follow-up. Medication changes were frequent, with 57.7% of patients having a medication addition and 48.6% discontinuing medication. The sequence of medication changes varied greatly across patients. Multiple respiratory medication use was common, with 29% of patients dispensed 3 to 4 medication classes in 1 year.
Many COPD patients who are started on medication management undergo changes in prescribed pharmacotherapy and are taking multiple medications. Despite clinical practice guidelines, there is an ad hoc nature of COPD medication management, and such heterogeneity challenges the ability to estimate relationships between drug exposure and outcomes using real-world data.
为了更好地了解药物的使用方式以及用于治疗患者的治疗方案的复杂性，我们对一组新诊断的慢性阻塞性肺疾病（COPD）患者的用药模式以及患者联合使用不同类别药物的程度和随时间的变化情况进行了描述。
本研究的目的是描述用药模式，包括在一组新诊断的COPD患者中患者联合使用不同类别药物的程度和随时间的变化情况，并确定处方配药有缺漏的患者比例。
我们从退伍军人事务医疗保健系统中确定了一组在1999年至2003年期间新诊断为COPD的患者。利用处方配药信息，我们对1年内使用短效β受体激动剂（SABA）、长效β受体激动剂（LABA）、短效抗胆碱能药物（如异丙托溴铵[IPRA]）和吸入性糖皮质激素（ICS）的患病率和发病率进行了量化。我们还描述了药物添加和停用的顺序以及处方配药之间的缺漏情况。在随访90天、180天和365天时总结了多种呼吸药物使用的患病率。
在133737例新诊断为COPD的患者中，大多数（80.0%）使用了SABA，其次在1年随访期间，40.0%使用IPRA，33.2%使用ICS，16.0%使用LABA。用药变化频繁，57.7%的患者有药物添加，48.6%的患者停用药物。不同患者之间用药变化的顺序差异很大。多种呼吸药物联合使用很常见，29%的患者在1年内使用了3至4类药物。
许多开始接受药物治疗管理的COPD患者在规定的药物治疗方面会发生变化，并且正在服用多种药物。尽管有临床实践指南，但COPD药物治疗管理具有临时性，这种异质性挑战了使用真实世界数据估计药物暴露与结局之间关系的能力。
