Treatment of COPD Groups GOLD A and B with Inhaled Corticosteroids in the COSYCONET Cohort - Determinants and Consequences.
COPD
GOLD groups
inhaled corticosteroids
overtreatment
Journal
International journal of chronic obstructive pulmonary disease
ISSN: 1178-2005
Titre abrégé: Int J Chron Obstruct Pulmon Dis
Pays: New Zealand
ID NLM: 101273481
Informations de publication
Date de publication:
Historique:
received:
03
02
2021
accepted:
23
03
2021
entrez:
22
4
2021
pubmed:
23
4
2021
medline:
28
7
2021
Statut:
epublish
Résumé
In COPD patients of GOLD groups A and B, a high degree of treatment with inhaled corticosteroids (ICS) has been reported, which is regarded as overtreatment according to GOLD recommendations. We investigated which factors predict ICS use and which relationship it has to clinical and functional outcomes, or healthcare costs. We used pooled data from visits 1 and 3 of the COSYCONET cohort (n=2741, n=2053, interval 1.5 years) including patients categorized as GOLD grades 1-4 and GOLD group A or B at both visits (n=1080). Comparisons were performed using ANOVA, and regression analyses using propensity matching and inverse probability weighting to adjust for differences between ICS groups. These were defined as having ICS at both visits (always) vs no ICS at both visits (never). Measures were divided into predictors of ICS treatment and outcomes. Among 1080 patients, 608 patients were eligible for ICS groups (n=297 never, n=311 always). Prior to matching, patients with ICS showed significantly (p<0.05 each) impaired lung function, symptoms and exacerbation history. After matching, the outcomes generic quality of life and CO diffusing capacity were increased in ICS patients (p<0.05 each). Moreover, costs for respiratory medication, but not total health care costs, were significantly elevated in the ICS group by 780€ per year. ICS therapy in COPD GOLD A/B patients can have small positive and negative effects on clinical outcomes and health care costs, indicating that the clinical evaluation of ICS over-therapy in COPD requires a multi-dimensional approach.
Sections du résumé
BACKGROUND
BACKGROUND
In COPD patients of GOLD groups A and B, a high degree of treatment with inhaled corticosteroids (ICS) has been reported, which is regarded as overtreatment according to GOLD recommendations. We investigated which factors predict ICS use and which relationship it has to clinical and functional outcomes, or healthcare costs.
METHODS
METHODS
We used pooled data from visits 1 and 3 of the COSYCONET cohort (n=2741, n=2053, interval 1.5 years) including patients categorized as GOLD grades 1-4 and GOLD group A or B at both visits (n=1080). Comparisons were performed using ANOVA, and regression analyses using propensity matching and inverse probability weighting to adjust for differences between ICS groups. These were defined as having ICS at both visits (always) vs no ICS at both visits (never). Measures were divided into predictors of ICS treatment and outcomes.
RESULTS
RESULTS
Among 1080 patients, 608 patients were eligible for ICS groups (n=297 never, n=311 always). Prior to matching, patients with ICS showed significantly (p<0.05 each) impaired lung function, symptoms and exacerbation history. After matching, the outcomes generic quality of life and CO diffusing capacity were increased in ICS patients (p<0.05 each). Moreover, costs for respiratory medication, but not total health care costs, were significantly elevated in the ICS group by 780€ per year.
CONCLUSION
CONCLUSIONS
ICS therapy in COPD GOLD A/B patients can have small positive and negative effects on clinical outcomes and health care costs, indicating that the clinical evaluation of ICS over-therapy in COPD requires a multi-dimensional approach.
Identifiants
pubmed: 33883892
doi: 10.2147/COPD.S304532
pii: 304532
pmc: PMC8053704
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Bronchodilator Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
987-998Informations de copyright
© 2021 Lutter et al.
Déclaration de conflit d'intérêts
Professor Tobias Welte reports grants from German Ministry of Research and Education, during the conduct of the study; personal fees from AstraZeneca, GSK, Novartis, and Chiesi, outside the submitted work. Professor Robert Bals reports grants from Bundesministerium für Bildung und Forschung, during the conduct of the study; outside the submitted work. Professor Claus F. Vogelmeier reports grants, personal fees from AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi; grants from GlaxoSmithKline, Grifols, Menarini, Novartis, Nuvaira, and MeddUpdate, outside the submitted work. The authors declare that they have no other competing interests.
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