Primary Care University Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
Pneumology Department, Hospital Universitari Vall d́Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; Medicine Department, Autonomous University of Barcelona (UAB), Bellaterra (Cerdanyola del Vallés), Barcelona, Spain.
Arch Bronconeumol (Engl Ed). 2021 Mar;57(3):205-213. doi: 10.1016/j.arbres.2020.07.032. Epub 2020 Sep 29.
Recent data from real world clinical practices on the use of Triple Therapy (TT) in patients with COPD are scarce.
Observational population-based study with longitudinal follow-up in patients with COPD identified in a primary care electronic medical records database in Catalonia, covering 80% of the general population. The aims were to characterize COPD patients who initiated TT and to describe treatment pathways before and after TT initiation. Time to and probability of step down or complete discontinuation of TT was described using restricted mean survival time and Kaplan-Meier analysis.
A total of 34,018 COPD patients initiated TT during the study period. Of them, 23,867 (70.1%) were GOLD A/B. 18,453 (54.2%) were non-exacerbators, 9931 (29.2%) infrequent exacerbators, 5634 (16.5%) frequent exacerbators and 1923 (5.6%) had asthma-COPD overlap. Drugs most frequently used prior to initiation of TT were long-acting antimuscarinics (22.5%) and combination of long-acting beta2 agonists/inhaled corticosteroids (15.2%). A total of 11,666 (34.3%) stepped down and 1091 (3.2%) discontinued TT during follow-up. Step down following TT was more likely in patients with severe COPD, especially during the first year; however, discontinuation was more common among patients with mild COPD.
Most patients initiating treatment with TT were non exacerbators and continued on the same treatment over time regardless severity of disease. Stepping down was more frequent in severe patients, while discontinuation was more common among mild patients. Overall, it appears that TT is extensively used in primary care for treatment of patients with COPD.
关于 COPD 患者使用三联疗法（TT）的真实世界临床实践数据较为匮乏。
这是一项基于人群的观察性研究，对加泰罗尼亚初级保健电子病历数据库中识别出的 COPD 患者进行了纵向随访。该数据库覆盖了 80%的普通人群。研究目的是对开始接受 TT 治疗的 COPD 患者进行特征描述，并描述 TT 治疗开始前后的治疗途径。采用限制平均生存时间和 Kaplan-Meier 分析描述 TT 停药或完全停药的时间和概率。
在研究期间，共有 34018 例 COPD 患者开始接受 TT 治疗。其中，23867 例（70.1%）为 GOLD A/B 期。18453 例（54.2%）为非加重者，9931 例（29.2%）为偶发加重者，5634 例（16.5%）为频发加重者，1923 例（5.6%）为哮喘-COPD 重叠。在开始 TT 治疗之前，最常使用的药物是长效抗毒蕈碱药物（22.5%）和长效β2 激动剂/吸入性皮质类固醇的联合制剂（15.2%）。在随访期间，共有 11666 例（34.3%）患者降级，1091 例（3.2%）患者停用 TT。在 TT 治疗后，严重 COPD 患者更有可能降级，尤其是在第一年；然而，轻度 COPD 患者更常见的是停药。
大多数开始接受 TT 治疗的患者是非加重者，无论疾病严重程度如何，随着时间的推移，他们都持续接受相同的治疗。在严重患者中，降级更为常见，而在轻度患者中，停药更为常见。总的来说，TT 在初级保健中广泛用于治疗 COPD 患者。
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