New inhaled COPD maintenance medication prescriptions rise in recent years

Key takeaways:

• This analysis spanned from 2016 to 2022.
• Nearly 50% of patients were initially prescribed LABA/inhaled corticosteroids.

BOSTON — Compared with 17,800 patients starting new inhaled COPD maintenance therapy in 2016, 32,558 patients started a new inhaled treatment in 2022, according to a presentation at the CHEST Annual Meeting.

In this retrospective cohort study, Trishul Siddharthan, MD, associate professor of medicine at University of Miami, and colleagues evaluated 191,823 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 find out how the number of patients prescribed to these types of treatments has changed from 2016 to 2022.

Within this timeframe, researchers observed higher numbers of patients beginning new inhaled COPD maintenance therapy in recent vs. past years. Compared with 17,800 patients in 2016, this number went up to 24,705 in 2017, 27,259 in 2018 and 30,734 in 2019. It should be noted that the number of patients starting inhaled maintenance therapy dropped to 27,109 in 2020 but went back up in 2021 with 31,658 patients and in 2022 with 32,558 patients.

Of the six studied inhaled COPD maintenance treatments, nearly half of the total cohort (48%) had been initially prescribed long-acting beta agonist/inhaled corticosteroid. The remaining treatments were prescribed to smaller proportions of patients, with 19% prescribed a long-acting muscarinic antagonist, 18% prescribed LAMA/LABA, 10% prescribed LAMA/LABA/ICS via a single inhaler, 3% prescribed LAMA/LABA/ICS via multiple inhalers and 1% prescribed LABA, according to the presentation.

“The fact that so many patients with COPD are on LABA/ICS is impactful, as these medications are not currently in the guidelines for the management of COPD,” Siddharthan told Healio. “Furthermore, there is increasing evidence that ICS increase the risk of a range of deleterious health outcomes among those with COPD including pneumonia.”

Looking at the number of patients prescribed to each therapy by year, researchers reported that LABA/ICS prescriptions decreased with each passing year (2016, 56%; 2017, 53%; 2018, 50%; 2019, 48%; 2020, 48%; 2021, 44%; 2022, 42%).

“For the everyday clinician, the takeaway is we should focus on step-up therapy according to GOLD guidelines, with the administration of ICS only in the setting of eosinophilia,” Siddharthan told Healio.

Similarly, initial prescriptions for LAMA went down as time went on (2016, 25%; 2017, 22%; 2018, 20%; 2019, 19%; 2020, 18%; 2021, 17%; 2022, 16%), according to the presentation. Although lower to begin with, fewer patients also received prescriptions for LAMA/LABA/ICS in multiple inhalers moving into more recent years (2016, 5%; 2017, 5%; 2018, 4%; 2019, 3%; 2020, 2%; 2021, 2%; 2022, 2%).

After LAMA/LABA/ICS in a single inhaler was introduced in late 2017, researchers found rises in the number of patients prescribed this therapy with each new year (2018, 3%; 2019, 8%; 2020, 11%; 2021, 19%; 2022, 24%).

From 2016 to 2018, the proportion of patients initially prescribed LAMA/LABA went up (2016, 12%; 2017, 20%; 2018, 22%). This proportion started falling in 2019 (21%) and continued to decline as time went on (2020, 20%; 2021, 17%; 2022, 15%).

Lastly, researchers observed no changes in initial LABA prescriptions from 1% during the assessed timeframe.

“There is a need for more targeted therapy for COPD across the board,” Siddharthan told Healio. “The data presented demonstrate a) a good number of patients with COPD are not on guideline-based therapy and b) those that are continue to have frequent exacerbations.

“Future studies are needed to further understand health outcomes among those prescribed ICS, particularly among those above the age of 65,” Siddharthan added.

For more information:

Trishul Siddharthan, MD, can be reached at tsiddhar@miami.edu.