Prescription Patterns of New Use of Fixed-Dose Combination Inhalers in Patients with Chronic Obstructive Pulmonary Disease: Long-Acting β2 Agonists Plus Long-Acting Muscarinic Antagonists versus Long-Acting β2 Agonists Plus Inhaled Corticosteroids

Abstract

Pei-An Liao,1 Sheng-Wei Pan,2,3 Chun-Yu Chen,4,5 Chung-Yeh Deng,1,4 Yaa-Hui Dong1,4,5 1Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 2Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; 3Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 5Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, TaiwanCorrespondence: Yaa-Hui Dong, Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, 155, Sec 2, Linong Street, Taipei, 112, Taiwan, Tel [phone], Fax [phone], Email [email protected]: The clinical guideline recommends use of long-acting β 2 agonists/long-acting muscarinic antagonists (LABA/LAMA) or long-acting β 2 agonists/inhaled corticosteroids (LABA/ICS) combination therapies for patients with severe chronic obstructive pulmonary disease (COPD). The fixed-dose combination (FDC) inhalers of LABA/LAMA and LABA/ICS were reimbursed in Taiwan in 2015 and in 2002, respectively. This study aimed to examine prescription patterns of new use of either FDC therapy in real-world practice.Methods: We identified COPD patients who initiated LABA/LAMA FDC or LABA/ICS FDC between 2015 and 2018 from a population-based Taiwanese database with 2 million, randomly sampled beneficiaries enrolled in a single-payer health insurance system. We compared number of LABA/LAMA FDC and LABA/ICS FDC initiators in each calendar year, from different hospital accreditation levels, and cared for by different physician specialties. We also compared baseline patient characteristics between LABA/LAMA FDC and LABA/ICS FDC initiators.Results: A total of 12,455 COPD patients who initiated LABA/LAMA FDC (n=4019) or LABA/ICS FDC (n=8436) were included. Number of LABA/LAMA FDC initiators increased apparently (n=336 in 2015 versus n=1436 in 2018), but number of LABA/ICS FDC initiators decreased obviously (n=2416 in 2015 versus n=1793 in 2018) over time. The preference of use of LABA/LAMA FDC varied across clinical environments. The proportions of LABA/LAMA FDC initiators were more than 30% in the setting of non-primary care clinics (eg, medical centers) and in the services of chest physicians; but were only less than 10% in primary care clinics and non-chest physicians’ services (eg, family medicine physicians). LABA/LAMA FDC initiators appeared to be older, male, to have more comorbidities, and to utilize resources more frequently compared to LABA/ICS FDC initiators.Conclusion: This real-world study found evident temporal trends, variations in healthcare provider, and differences in patient characteristics among COPD patients who initiated LABA/LAMA FDC or LABA/ICS FDC.Keywords: chronic obstructive pulmonary disease, new users, long-acting β 2 agonists/long-acting muscarinic antagonists fixed-dose combination, LABA/LAMA FDC, long-acting β 2 agonists/inhaled corticosteroids fixed-dose combination, LABA/ICS FDC, temporal trends, healthcare provider characteristics, patient characteristics

Keywords

• chronic obstructive pulmonary disease
• new users
• long-acting β2 agonists/long-acting muscarinic antagonists fixed-dose combination
• laba/lama fdc
• long-acting β2 agonists/inhaled corticosteroids fixed-dose combination
• laba/ics fdc
• temporal trends
• healthcare provider characteristics
• patient characteristics