Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
BMJ Open Respir Res. 2024 Feb 27;11(1):e002127. doi: 10.1136/bmjresp-2023-002127.
There is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice.
This retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots.
In four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%-47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%-33.2% for asthma and 27.0%-52.2% for COPD) from the USA as compared with EHR databases (6.9%-15.2% for asthma and 4.4%-17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments.
Real-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients' needs.
目前对于全球范围内哮喘或慢性阻塞性肺疾病（COPD）患者的实际治疗方法知之甚少，尤其是在新诊断患者的初始药物治疗和不同的治疗轨迹方面。了解这些信息对于监测和改进临床实践非常重要。
本回顾性队列研究旨在通过来自四个索赔（药物配给）和四个电子健康记录（EHR；药物处方）数据库的数据，分析来自六大洲三个国家的 130 万名哮喘或 COPD 患者的治疗方法。我们分析了从首次诊断开始的药物类别治疗轨迹，并以太阳辐射图的形式进行可视化。
在四个国家（美国、英国、西班牙和荷兰），大多数哮喘成人患者开始接受短效β2 激动剂单药治疗（一线治疗的 20.8%-47.4%）。对于 COPD，不同国家的一线治疗方法有所不同。在索赔数据库中（美国为哮喘的 14.5%-33.2%和 COPD 的 27.0%-52.2%），未接受治疗的患者比例最大（哮喘和 COPD），而在 EHR 数据库中（欧洲国家为哮喘的 6.9%-15.2%和 COPD 的 4.4%-17.5%）。治疗轨迹显示出治疗的逐步上升和下降。
来自索赔和 EHR 的真实世界数据表明，哮喘和 COPD 的一线治疗方法在各国之间存在很大差异。我们发现哮喘和 COPD 的药物治疗存在逐步治疗的证据，表明治疗可能根据患者的需求进行调整。
