Real-world use of various types of respiratory medication in chronic obstructive pulmonary disease (COPD) appears consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations, according to study findings published in Therapeutic Advances in Respiratory Disease.
Investigators analyzed patient data from the COSYNET trial (COPD and Systemic Consequences – Comorbidities Network; ClinicalTrials.gov Identifier: NCT01245933) to determine factors associated with real-world COPD medication use.
The COSYCONET trial is an ongoing, noninterventional COPD study conducted at in 31 centers across Germany. Participants (all with COPD, GOLD grades 0-4) were required to have 2 to 5 follow-up visits over 4.5 years following enrollment. Those who had exacerbations within 4 weeks of a follow-up visit were excluded from the COSYNET cohort.
In the current study, investigators included data collected from 2010 to 2018 on 1043 COSYNET cohort members (mean [SD] age, 63.64 [8.31] years; 42% women; 22% who actively smoked) with forced expiratory volume in 1 second (FEV1) mean (SD) percent predicted 61.3% (20.1); forced vital capacity (FVC) mean percent predicted, 82.9% (18.0); FEV1/FVC mean ratio, 0.57 (0.13). Use of respiratory medication was dependent on GOLD grades 0 to 4 and groups A to D (majority of participants in grades 2 [42%] and 3 [27%] and in groups A [49%] and B [20%]).
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In an observational cohort of patients with COPD, use of maintenance COPD medication, including LABA, LAMA, ICS, and their combinations was dependent on disease severity as indicated by GOLD grades and groups.
Overall, 77% of cohort members were receiving long-acting beta 2-agonists (LABA) with no trend across follow-up visits, and 60% of participants reported use of any inhaled corticosteroid (ICS) with a nonsignificant decrease across the final follow-up visits. Overall, 70% of participants were receiving long-acting muscarinic antagonists (LAMA) with a significant increase across follow-up visits. The investigators noted a significant increase over follow-up visits for dual bronchodilation with LABA+LAMA (62% of participants), and no significant trend for triple therapy use or for LABA+ICS use.
Low diffusing capacity of the lungs for carbon monoxide (DLCO) was associated with LAMA therapy. Higher use of all maintenance medication categories except LAMA was associated with an asthma diagnosis. Conversely, diabetes was associated with lower use of all maintenance medication categories, with the exception of LABA.
Among women, there was less use of ICS, LABA+ICS, and triple therapy. Higher use of LABA was associated with elevated body mass index. Active smoking was linked with less maintenance therapy compared with nonsmoking or previous smoking. Among the 8 categories in the COPD Assessment Test, only stair and hill climbing were associated consistently with treatment. No associations were noted between higher age and any maintenance medication category.
Study limitations include the observational design, which was able to assess only associations, not causation. Additionally, study conditions were close to real-life but may not exactly simulate real-world circumstances.
“In an observational cohort of patients with COPD, use of maintenance COPD medication, including LABA, LAMA, ICS, and their combinations was dependent on disease severity as indicated by GOLD grades and groups,” the study authors concluded, adding that they also “identified factors linked to the use of various types of respiratory COPD medication.”
Disclosure: This research was supported by Novartis Pharma GmbH. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. The COSYCONET trial is supported by AstraZeneca GmbH, Bayer Schering Pharma AG, Boehringer Ingelheim Pharma GmbH & Co. KG, Chiesi GmbH, GlaxoSmithKline, Grifols Deutschland GmbH, MSD Sharp & Dohme GmbH, Mundipharma GmbH, Novartis Deutschland GmbH, Pfizer Pharma GmbH, Takeda Pharma Vertrieb GmbH & Co. KG, Teva GmbH for patient investigations and laboratory measurements.
