Monteagudo Mònica, Roset Montse, Rodriguez-Blanco Teresa, Muñoz Laura, Miravitlles Marc
Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
Int J Chron Obstruct Pulmon Dis. 2017 Apr 12;12:1145-1152. doi: 10.2147/COPD.S131016. eCollection 2017.
To describe and compare demographic and clinical profile of patients newly initiated on aclidinium (ACL) or tiotropium (TIO) and identify factors associated with newly initiated ACL in real-life clinical practice during 2013 in Catalonia.
We performed a population-based, retrospective, observational study with data obtained from the Information System for Research Development in Primary Care, a population database that contains information of 5.8 million inhabitants (more than 80% of the Catalan population). Patients over 40 years old, with a recorded diagnosis of COPD and newly initiated treatment with either ACL or TIO during the study period (January to December 2013), were selected. A descriptive analysis of demographic and clinical characteristics was performed, and treatment adherence was also assessed for both cohorts.
A total of 8,863 individuals were identified, 4,293 initiated with ACL and 4,570 with TIO. They had a mean age of 69.4 years (standard deviation: 11.3), a median COPD duration of 3 years (interquartile range: 0-8), and 71% were males. Patients treated with ACL were older, with more respiratory comorbidities, a longer time since COPD diagnosis, worse forced expiratory volume in 1 second (% predicted), and with a higher rate of exacerbations during the previous year compared with TIO. It was found that 41.3% of patients with ACL and 62.3% of patients with TIO had no previous COPD treatment. Inhaled corticosteroid and long-acting β2-agonist were the most frequent concomitant medications (32.9% and 32.6%, respectively). Approximately 75% of patients were persistent with ACL or TIO at 3 months from the beginning of treatment, and more than 50% of patients remained persistent at 9 months.
Patients initiated with ACL had more severe COPD and were taking more concomitant respiratory medications than patients initiated with TIO. ACL was more frequently initiated as part of triple therapy, while TIO was more frequently initiated as monotherapy.
描述并比较新启用阿地溴铵（ACL）或噻托溴铵（TIO）的患者的人口统计学和临床特征，并确定2013年加泰罗尼亚实际临床实践中与新启用ACL相关的因素。
我们进行了一项基于人群的回顾性观察研究，数据来自初级保健研究发展信息系统，这是一个包含580万居民（超过加泰罗尼亚人口的80%）信息的人口数据库。选择年龄超过40岁、有慢性阻塞性肺疾病（COPD）记录诊断且在研究期间（2013年1月至12月）新启用ACL或TIO治疗的患者。对人口统计学和临床特征进行了描述性分析，并评估了两个队列的治疗依从性。
共识别出8863人，4293人启用ACL，4570人启用TIO。他们的平均年龄为69.4岁（标准差：11.3），COPD中位病程为3年（四分位间距：0 - 8），71%为男性。与TIO相比，接受ACL治疗的患者年龄更大，有更多的呼吸系统合并症，自COPD诊断以来的时间更长，1秒用力呼气量（%预计值）更差，且前一年的急性加重率更高。发现41.3%的ACL患者和62.3%的TIO患者之前未接受过COPD治疗。吸入性糖皮质激素和长效β2受体激动剂是最常用的联合用药（分别为32.9%和32.6%）。从治疗开始3个月时，约75%的患者持续使用ACL或TIO，9个月时超过50%的患者仍持续使用。
与启用TIO的患者相比，启用ACL的患者COPD更严重，服用的联合呼吸系统药物更多。ACL更常作为三联疗法的一部分启用，而TIO更常作为单一疗法启用。
