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Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

PURPOSE: Oral corticosteroids (OCS) play a role in the treatment of acute chronic obstructive pulmonary disease (COPD) exacerbations; however, chronic use is not recommended due to the high rate of systemic complications, development of comorbidities, and increased mortality. Data assessing the real...

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Autores principales: Bogart, Michael, Abbott, Carl B, Bangalore, Mohan, McMorrow, Donna, Packnett, Elizabeth R, DiRocco, Kristi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625739/
https://www.ncbi.nlm.nih.gov/pubmed/37933243
http://dx.doi.org/10.2147/COPD.S419272
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author Bogart, Michael
Abbott, Carl B
Bangalore, Mohan
McMorrow, Donna
Packnett, Elizabeth R
DiRocco, Kristi
author_facet Bogart, Michael
Abbott, Carl B
Bangalore, Mohan
McMorrow, Donna
Packnett, Elizabeth R
DiRocco, Kristi
author_sort Bogart, Michael
collection PubMed
description PURPOSE: Oral corticosteroids (OCS) play a role in the treatment of acute chronic obstructive pulmonary disease (COPD) exacerbations; however, chronic use is not recommended due to the high rate of systemic complications, development of comorbidities, and increased mortality. Data assessing the real-world impact of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) on OCS utilization rates are limited. This study assessed the impact of FF/UMEC/VI on OCS use among patients with COPD previously treated with OCS. PATIENTS AND METHODS: A retrospective database study of patients with COPD aged ≥40 years who initiated FF/UMEC/VI from 1 November 2017 to 31 December 2018, identified through the MarketScan(®) Commercial and Medicare Supplemental databases. Patients were required to have ≥1 dispensing of an OCS prior to initiation of FF/UMEC/VI (index) and were followed up for 12 months post-index. OCS utilization patterns, potential OCS-related adverse events, healthcare resource utilization (HCRU), and costs were compared between the 12-month pre- and post-index periods. RESULTS: A total of 2013 patients were identified (mean age 63.5 years, 55.7% female). The proportion of patients with ≥1 OCS claim decreased by 32.2% between the pre- and post-index period (67.8% vs 100%; p < 0.001). Comparing the post-index period to the pre-index period, mean number of OCS pharmacy claims per patient decreased from 3.3 to 2.5 (p < 0.001) and mean daily dose was reduced from 3.1 to 2.6 mg/day (p = 0.004); 30.0% of patients reduced their daily dose by 90–100%. Reductions were also seen in COPD-related HCRU. The proportion of patients with an inpatient admission for COPD decreased from 11.4% to 7.1% (p < 0.001), emergency room visits decreased from 23.1% to 17.4% (p < 0.001), and office visits from 97.5% to 90.1% (p < 0.001). Similar results were seen for all-cause HCRU. CONCLUSION: Among patients with COPD with prior OCS use, FF/UMEC/VI initiation resulted in significant reductions in OCS utilization, COPD-related HCRU (including hospitalization), and all-cause HCRU.
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spelling pubmed-106257392023-11-06 Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI Bogart, Michael Abbott, Carl B Bangalore, Mohan McMorrow, Donna Packnett, Elizabeth R DiRocco, Kristi Int J Chron Obstruct Pulmon Dis Original Research PURPOSE: Oral corticosteroids (OCS) play a role in the treatment of acute chronic obstructive pulmonary disease (COPD) exacerbations; however, chronic use is not recommended due to the high rate of systemic complications, development of comorbidities, and increased mortality. Data assessing the real-world impact of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) on OCS utilization rates are limited. This study assessed the impact of FF/UMEC/VI on OCS use among patients with COPD previously treated with OCS. PATIENTS AND METHODS: A retrospective database study of patients with COPD aged ≥40 years who initiated FF/UMEC/VI from 1 November 2017 to 31 December 2018, identified through the MarketScan(®) Commercial and Medicare Supplemental databases. Patients were required to have ≥1 dispensing of an OCS prior to initiation of FF/UMEC/VI (index) and were followed up for 12 months post-index. OCS utilization patterns, potential OCS-related adverse events, healthcare resource utilization (HCRU), and costs were compared between the 12-month pre- and post-index periods. RESULTS: A total of 2013 patients were identified (mean age 63.5 years, 55.7% female). The proportion of patients with ≥1 OCS claim decreased by 32.2% between the pre- and post-index period (67.8% vs 100%; p < 0.001). Comparing the post-index period to the pre-index period, mean number of OCS pharmacy claims per patient decreased from 3.3 to 2.5 (p < 0.001) and mean daily dose was reduced from 3.1 to 2.6 mg/day (p = 0.004); 30.0% of patients reduced their daily dose by 90–100%. Reductions were also seen in COPD-related HCRU. The proportion of patients with an inpatient admission for COPD decreased from 11.4% to 7.1% (p < 0.001), emergency room visits decreased from 23.1% to 17.4% (p < 0.001), and office visits from 97.5% to 90.1% (p < 0.001). Similar results were seen for all-cause HCRU. CONCLUSION: Among patients with COPD with prior OCS use, FF/UMEC/VI initiation resulted in significant reductions in OCS utilization, COPD-related HCRU (including hospitalization), and all-cause HCRU. Dove 2023-11-01 /pmc/articles/PMC10625739/ /pubmed/37933243 http://dx.doi.org/10.2147/COPD.S419272 Text en © 2023 Bogart et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Bogart, Michael
Abbott, Carl B
Bangalore, Mohan
McMorrow, Donna
Packnett, Elizabeth R
DiRocco, Kristi
Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI
title Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI
title_full Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI
title_fullStr Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI
title_full_unstemmed Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI
title_short Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI
title_sort changes in oral corticosteroid utilization in patients with copd following initiation of ff/umec/vi
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10625739/
https://www.ncbi.nlm.nih.gov/pubmed/37933243
http://dx.doi.org/10.2147/COPD.S419272
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