使用慢性阻塞性肺疾病全球倡议（GOLD）标准对接受长效抗胆碱能药物单药治疗的慢性阻塞性肺疾病患者进行分类：一项与医保理赔相关的患者调查研究分析
Classification of Patients with COPD on LAMA Monotherapy Using the GOLD Criteria: Analysis of a Claims-Linked Patient Survey Study.
作者信息
Ray Riju, Hahn Beth, Stanford Richard H, White John, Essoi Breanna, Hunter Alyssa Goolsby
机构信息
US Medical Affairs, GSK, Research Triangle Park, NC, USA.
US Value Evidence and Outcomes, GSK, Research Triangle Park, NC, USA.
出版信息
Pulm Ther. 2019 Dec;5(2):191-200. doi: 10.1007/s41030-019-00099-0. Epub 2019 Aug 6.
INTRODUCTION
To address the burden of chronic obstructive pulmonary disease (COPD), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends treatment according to classification of patients by symptom severity and exacerbation risk. This post hoc analysis of a previously reported claims-linked, cross-sectional survey [study 205862 (HO-16-16642)] classified patients with COPD receiving long-acting muscarinic antagonist (LAMA) monotherapy based on the GOLD 2017 categories.
METHODS
Eligible patients who were ≥ 40 years of age, with ≥ 2 claims with International Classification of Diseases-10th Revision-Clinical Modification COPD diagnosis codes J40-J44 ≥ 30 days apart during the 12-month baseline period, and ≥ 2 claims for LAMA monotherapy in the 6 months prior to identification, were identified using claims data from the Optum Research Database. Patients completed a survey assessing modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT) scores and demographics; clinical characteristics were assessed from claims and survey data, while exacerbation history was assessed from claims data. GOLD symptom severity classifications were low (groups A and C) for patients with low scores on both the CAT and mMRC scales (scores of < 10 and 0-1, respectively), and high (groups B and D) for patients with high scores on either scale (scores of ≥ 10 and 2-4, respectively).
RESULTS
Of 433 patients included, 85.5% reported a CAT total score ≥ 10, and 45.5% reported mMRC grades 2-4. During the baseline period, 63.7% of patients had ≤ 1 moderate and 0 severe (hospitalized) exacerbations, and 36.3% had ≥ 1 severe or ≥ 2 moderate exacerbation(s). The proportions of patients with each GOLD classification were: A: 9.0%; B: 54.7%; C: 4.6%; D: 31.6%.
CONCLUSIONS
In this population, over 85% of LAMA monotherapy users have symptoms and/or exacerbation risk that may necessitate therapy escalation according to 2017 GOLD guidelines.
FUNDING
GlaxoSmithKline [study 205862 (HO-16-16642)].
引言
为应对慢性阻塞性肺疾病（COPD）的负担，慢性阻塞性肺疾病全球倡议组织（GOLD）建议根据症状严重程度和急性加重风险对患者进行分类治疗。这项对先前报告的与索赔相关的横断面调查[研究205862（HO-16-16642）]的事后分析，根据GOLD 2017分类对接受长效毒蕈碱拮抗剂（LAMA）单药治疗的COPD患者进行了分类。
方法
使用Optum研究数据库中的索赔数据，确定符合条件的患者，这些患者年龄≥40岁，在12个月的基线期内有≥2次间隔≥30天的国际疾病分类第10次修订版临床修正版COPD诊断代码J40-J44的索赔，并且在识别前6个月内有≥2次LAMA单药治疗的索赔。患者完成了一项评估改良医学研究委员会（mMRC）呼吸困难量表和COPD评估测试（CAT）分数以及人口统计学的调查；从索赔和调查数据中评估临床特征，同时从索赔数据中评估急性加重病史。对于CAT和mMRC量表得分均较低（分别<10分和0-1分）的患者，GOLD症状严重程度分类为低（A组和C组），对于任一量表得分较高（分别≥10分和2-4分）的患者，分类为高（B组和D组）。
结果
在纳入的433例患者中，85.5%报告CAT总分≥10分，45.5%报告mMRC分级为2-4级。在基线期，63.7%的患者有≤1次中度且无重度（住院）急性加重，36.3%的患者有≥1次重度或≥2次中度急性加重。各GOLD分类患者的比例为：A组：9.0%；B组：54.7%；C组：4.6%；D组：31.6%。
结论
在该人群中，超过85%的LAMA单药治疗使用者的症状和/或急性加重风险可能需要根据2017年GOLD指南升级治疗。
资助
葛兰素史克公司[研究205862（HO-16-16642）]。
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