Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand.
Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Respirology. 2018 Jun;23(6):583-592. doi: 10.1111/resp.13235. Epub 2017 Dec 18.
While several studies have found that prescribing practices do not conform to chronic obstructive pulmonary disease (COPD) treatment guidelines, none have examined longitudinal patterns of use of long-acting beta -agonist (LABA) and long-acting muscarinic antagonist (LAMA) therapy across an entire country. We undertook a nationwide follow-up study to describe treatment patterns in new users of long-acting bronchodilators.
National health and pharmaceutical dispensing data were used to identify patients aged ≥45 years who initiated LABA and/or LAMA therapy for COPD between 1 February 2006 and 31 December 2013. Dispensings of LABAs, LAMAs and inhaled corticosteroids (ICSs) were aggregated into episodes of use of therapeutic regimens. Kaplan-Meier curves, sunburst plots and sequence index plots were generated to summarize, respectively, the duration of the first regimen, the sequences in which unique regimens were used and the patterns of use and non-use during follow-up.
The study cohort included 83 435 patients with 290 400 person-years of follow-up. The most commonly initiated regimen was a LABA with an ICS. ICS use was inconsistent with international guidelines: over- and under-treatment occurred in patients with infrequent and frequent exacerbations, respectively, and ICS monotherapy was common. The median duration of the first regimen was 46 days. Many patients used multiple regimens over time and periods of non-use were common.
In this nationwide study, patterns of use of LABAs, LAMAs and ICSs were complex and often did not comply with treatment guidelines. Further work is required to address the discrepancy between guidelines and prescribing practices.
尽管多项研究发现，处方实践不符合慢性阻塞性肺疾病（COPD）治疗指南，但没有一项研究调查过整个国家范围内长效β-激动剂（LABA）和长效抗胆碱能药物（LAMA）治疗的纵向使用模式。我们进行了一项全国性随访研究，以描述新使用长效支气管扩张剂的患者的治疗模式。
使用国家卫生和药品配药数据，确定在 2006 年 2 月 1 日至 2013 年 12 月 31 日期间，年龄≥45 岁的患者因 COPD 开始使用 LABA 和/或 LAMA 治疗。LABA、LAMA 和吸入性皮质类固醇（ICS）的配药被汇总为治疗方案的使用阶段。生成 Kaplan-Meier 曲线、太阳图和序列指数图，分别总结首次治疗方案的持续时间、独特治疗方案的使用顺序以及随访期间的使用和不使用模式。
研究队列包括 83435 名患者，随访 290400 人年。最常起始的方案是含有 ICS 的 LABA。ICS 的使用与国际指南不一致：ICS 治疗过度和治疗不足分别发生在频繁和不频繁加重的患者中，ICS 单药治疗很常见。首次治疗方案的中位持续时间为 46 天。许多患者随着时间的推移使用了多种方案，并且不使用的时期很常见。
在这项全国性研究中，LABA、LAMA 和 ICS 的使用模式复杂，并且经常不符合治疗指南。需要进一步努力解决指南与处方实践之间的差异。
