Background: Long-acting muscarinic antagonists (LAMA), long-acting β2-agonists (LABA) and fixed dose combinations (FDC) of inhaled corticosteroids (ICS) and LABA are used as inhaled maintenance therapies for COPD. Objective: To estimate persistence rates from dispensing patterns of long-acting inhaled drugs for COPD. Methods: From the PHARMO-database, COPD patients starting LAMA, LABA or LABA-ICS FDC between 2002 and 2006 were selected. Persistence with the initial as well as with any long-acting inhaled drug was determined, defined as time between start and stop of initial/any therapy, allowing ≤60-days gaps between refills. For patients who did not continue to receive dispensings of the initial therapy for at least one year, the first change in therapy was determined. Results: The study included 2201 LAMA, 1201 LABA and 4146 LABA-ICS FDC users. Persistence rates with initial therapy alone at 1, 2, and 3 years were 25%, 14%, 8% for LAMA, 21%, 10%, 6% for LABA and 27%, 14%, 8% for LABA-ICS FDC. Of patients who did not persist with LAMA alone for one year, 15% added and 13% switched therapy (both mostly LABA-ICS FDC). Of patients not persisting with LABA alone, 9% added therapy (mostly LAMA) and 31% switched therapy (mostly to LABA-ICS FDC). In patients not persisting with LABA-ICS FDC, add-on and switch occurred equally frequent (11%, mostly LAMA). Persistence rates with any long-acting drug at 1, 2 and 3 years were 36%, 23% and 17% respectively. Conclusion: Persistence with the initial as well as with any long-acting inhaled drug in COPD is low, with a substantial proportion of patients changing therapy.

COPD, Long-acting inhaled drug, Persistence, Treatment pattern
dx.doi.org/10.1016/j.rmed.2010.07.007, hdl.handle.net/1765/31756
Respiratory Medicine
Erasmus MC: University Medical Center Rotterdam

Penning-Van Beest, F.J.A, van Herk-Sukel, M.P.P, Gale, R.E, Lammers, J.-W.J, & Herings, R.M.C. (2011). Three-year dispensing patterns with long-acting inhaled drugs in COPD: A database analysis. Respiratory Medicine, 105(2), 259–265. doi:10.1016/j.rmed.2010.07.007