Even with treatment, patients with COPD regularly become frequent exacerbators
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Key takeaways:
- During a 5-year period, 45,079 of 156,462 patients with GOLD A/B COPD progressed to GOLD E.
- More patients moved to GOLD E as years passed from the start of inhaled medication.
BOSTON — Moving from Global Initiative for Chronic Obstructive Lung Disease, or GOLD, group A/B to group E was common among patients starting a new inhaled maintenance medication, according to a presentation at the CHEST Annual Meeting.
“The majority of patients with GOLD A/B COPD progressed to GOLD E within 5 years, despite treatment with inhaled maintenance therapies,” Emily S. Wan, MD, MPH, assistant professor of medicine at Harvard Medical School, and colleagues wrote on a presentation slide.
In a retrospective cohort study, Wan and colleagues assessed 156,462 adults with COPD starting a new inhaled maintenance medication via Optum’s Clinformatics Data Mart database of U.S. individuals on Medicare or commercial insurance plans to uncover how many patients originally grouped in GOLD A/B (less than two moderate exacerbations + no severe exacerbations in 12 months before starting new maintenance medication) move to GOLD E (two moderate or one severe exacerbation 1 year after starting new maintenance medication).
As Healio previously reported, after progressing to GOLD group E, patients with COPD faced higher costs and used health care resources more.
To capture a more detailed look at who progressed to GOLD E, researchers divided the GOLD A/B population into those with no moderate and severe exacerbations (GOLD A/B0; n = 112,324; mean age, 71 years; 51% men; 74% white) and those with one moderate and no severe exacerbations (GOLD A/B1; n = 44,138; mean age, 70 years; 47% men; 74% white).
In both groups, the majority of patients had been prescribed long-acting beta-2 agonist/inhaled corticosteroid (GOLD A/B0, 45%; GOLD A/B1, 51%).
Other inhaled COPD maintenance medications were prescribed to smaller proportions of patients, including LABA/long-acting muscarinic antagonist (GOLD A/B0, 20%; GOLD A/B1, 17%), LAMA alone (20%; 16%), LABA/LAMA/ICS in a single inhaler (12%; 13%), LABA/LAMA/ICS in multiple inhalers (both 2%) and LABA alone (both 1%).
During a 5-year period, 45,079 patients progressed to GOLD E, of which more came from the GOLD A/B0 vs. GOLD A/B1 group (26,644 vs. 18,435), according to Wan’s presentation.
Within the GOLD A/B0 COPD group, researchers found that more patients moved to GOLD E as years passed from the start of treatment. At the 1-year mark, 17% of patients progressed to GOLD E, and this grew to 30% at year 2 and then 53% at year 5.
A similar pattern was observed in the GOLD A/B1 COPD group, with a higher proportion of patients transitioning to GOLD E as more time went by since the beginning of treatment. According to the presentation, 41% progressed to GOLD E at the 1-year mark, and this increased to 52% at 2 years and 71% at 5 years.
Researchers also reported that the risk for GOLD E progression was significantly higher among those grouped under GOLD A/B1 compared with those grouped under GOLD A/B0 (HR = 2.92; 95% CI, 2.84-3; P < .001).
“Given [these] data [show] all patients are at risk for exacerbating while on treatment, additional treatment strategies are needed to lower exacerbation risk in patients with COPD,” Wan and colleagues wrote on the presentation slide.