Severe COPD Exacerbation Risk and Long-Acting Bronchodilator Treatments: Comparison of Three Observational Data Analysis Methods

被引：0

作者：

Roberts M.H. ^{[1
,2
]}

Mapel D.W. ^{[1
]}

Borrego M.E. ^{[2
]}

Raisch D.W. ^{[2
]}

Georgopoulos L. ^{[2
]}

van der Goes D. ^{[3
]}

机构：

[1] Health Services Research Division, LCF Research, 2309 Renard Place SE, Suite 103, Albuquerque, 87106, NM

[2] College of Pharmacy, University of New Mexico, Albuquerque, NM

[3] Department of Economics, University of New Mexico, Albuquerque, NM

来源：

Drugs - Real World Outcomes | 2015年 / 2卷 / 2期

关键词：

Chronic Obstructive Pulmonary Disease; Chronic Obstructive Pulmonary Disease Patient; Triple Therapy; Tiotropium; Severe Exacerbation;

D O I：

10.1007/s40801-015-0025-6

中图分类号：

学科分类号：

摘要：

Objective: Results from three observational methods for assessing effectiveness of long-acting bronchodilator therapies for reducing severe exacerbations of chronic obstructive pulmonary disease (COPD) were compared: intent-to-treat (ITT), as protocol (AP), and an as-treated analysis that utilized a marginal structural model (MSM) incorporating time-varying covariates related to treatment adherence and moderate exacerbations. Study Design and Setting: Severe exacerbation risk was assessed over a 2-year period using claims data for patients aged ≥40 years who initiated long-acting muscarinic antagonist (LAMA), inhaled corticosteroid/long-acting beta-agonist (ICS/LABA), or triple therapy (LAMA + ICS/LABA). Results: A total of 5475 COPD patients met inclusion criteria. Six months post-initiation, 53.5 % of patients discontinued using any therapy. The ITT analysis found an increased severe exacerbation risk for triple therapy treatment (hazard ratio [HR] 1.24; 95 % confidence interval [CI] 1.00–1.53). No increased risk was found in the AP (HR 1.00; 95 % CI 0.73–1.36), or MSM analyses (HR 1.11; 95 % CI 0.68–1.81). The MSM highlighted important associations among post-index events. Conclusion: Neglecting to adjust for treatment discontinuation may produce biased risk estimates. The MSM approach is a promising tool to compare chronic disease management by illuminating relationships between treatment decisions, adherence, patient choices, and outcomes. © 2015, The Author(s).

引用

页码：163 / 175

页数：12

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