Hahn Beth, Stanford Richard H, Hunter Alyssa Goolsby, White John, Essoi Breanna, Ray Riju
US Value Evidence and Outcomes, GSK, 5 Moore Drive, Research Triangle Park, NC, 27709-3398, USA.
Health Economics and Outcomes Research, Optum Life Sciences, 11000 Optum Circle, Eden Prairie, MN, 55344, USA.
Pulm Ther. 2019 Dec;5(2):179-190. doi: 10.1007/s41030-019-00098-1. Epub 2019 Aug 7.
Many patients with chronic obstructive pulmonary disease (COPD) prescribed long-acting muscarinic antagonist (LAMA) monotherapy remain symptomatic. This multivariable analysis of a previously reported claims-linked, cross-sectional survey assessed symptom burden measured by the COPD assessment test (CAT) in patients treated with LAMA monotherapy.
Eligible patients aged ≥ 40 years with COPD (≥ 2 International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] diagnosis codes ≥ 30 days apart during the 12-month baseline period) and ≥ 2 claims for LAMA monotherapy in the latter half of the baseline period were identified using claims data from the Optum Research Database. Patients completed a survey and 7-day daily diary; baseline clinical characteristics and resource utilization were assessed from claims data. Association between symptom burden and baseline characteristics was assessed using generalized linear regression modeling with normal distribution and identity link.
Overall, 433 patients prescribed LAMA monotherapy with claims-linked survey and diary data were included in the analysis. Most patients (85.5%) had a mean CAT score ≥ 10; 39.0% had scores ≥ 21. Overall, the factors most related to a clinically meaningful increase in CAT score (≥ 2 points) were being diagnosed with COPD for > 5 years and being a current smoker (2.25 points, P = 0.003 and 2.22 points, P = 0.025, respectively).
Results demonstrate that many patients with COPD receiving LAMA monotherapy remain symptomatic, especially those diagnosed > 5 years ago or those who continue to smoke. Use of patient-reported outcomes such as the CAT should be considered part of routine visits for patients with COPD.
GlaxoSmithKline (GSK study number 205862 [HO-16-16642]).
许多接受长效毒蕈碱拮抗剂（LAMA）单药治疗的慢性阻塞性肺疾病（COPD）患者仍有症状。这项对先前报告的索赔关联横断面调查的多变量分析评估了接受LAMA单药治疗患者中通过COPD评估测试（CAT）测量的症状负担。
使用Optum研究数据库中的索赔数据，确定符合条件的年龄≥40岁的COPD患者（在12个月基线期内有≥2个国际疾病分类第10版临床修订本[ICD-10-CM]诊断代码且间隔≥30天），并且在基线期后半段有≥2次LAMA单药治疗索赔。患者完成一项调查和7天的每日日记；从索赔数据中评估基线临床特征和资源利用情况。使用具有正态分布和恒等链接的广义线性回归模型评估症状负担与基线特征之间的关联。
总体而言，433名接受LAMA单药治疗且有索赔关联调查和日记数据的患者纳入分析。大多数患者（85.5%）的平均CAT评分≥10；39.0%的患者评分≥21。总体而言，与CAT评分临床上有意义的增加（≥2分）最相关的因素是COPD诊断超过5年以及当前吸烟者（分别为2.25分，P = 0.003和2.22分，P = 0.025）。
结果表明，许多接受LAMA单药治疗的COPD患者仍有症状，尤其是那些在5年前被诊断出的患者或继续吸烟的患者。应将使用患者报告的结局指标（如CAT）视为COPD患者常规就诊的一部分。
葛兰素史克公司（GSK研究编号205862 [HO-16-16642]）
