(P-256) Real-world Treatment Patterns of Newly Diagnosed Patients with Asthma And/or COPD

Background: Current guidelines provide clinical recommendations for asthma and COPD treatment, but there is a lack of knowledge how patients are treated in the real-world.

Objectives: To give insight in treatment patterns of newly diagnosed patients with asthma, COPD and asthma-COPD overlap (ACO) syndrome across three electronic data sources from the Netherlands, United Kingdom and United States.

Methods: The study was executed in three databases, two electronic health record databases, i.e. Integrated Primary Care Information (IPCI) from the Netherlands, Clinical Practice Research Datalink (CPRD) from the United Kingdom, and one claims databases from the United States: IBM MarketScan® Commercial Database (CCAE).

In each database, mapped to the OMOP-Common Data Model (CDM), we created three study cohorts by identifying adult patients with a first diagnosis of asthma, COPD or ACO respectively. Patients needed to have at least 1 year database observation time prior to incident diagnosis and 3 year follow-up time.

We studied treatment patterns at class level, including monotherapy treatments (SABA, ICS, LABA, etc.) and four fixed combinations (LABA-ICS, LABA-LAMA-ICS, SABA-SAMA, LABA-LAMA), for which we designed cohorts using the active ingredient and dose form of drugs in the OMOP-CDM. Treatment episodes were defined as continuous subscriptions from the same class with a maximum gap of 30 days between prescriptions. A prescription of another drug class was considered a switch if it had fewer than 30 days overlap with the previous drug class and a combination therapy otherwise. Results were visualized with sunburst plots of treatment patterns, which show the first treatment in the center and subsequent treatments in the surrounding outer layers.

Results: We identified a total of 566168, 115971 and 96985 newly diagnosed asthma, COPD and ACO patients across the databases. Approximately one-third of the asthma patients start with SABA followed by ICS in Europe and systemic steroid bursts in US. In Europe, COPD patients are starting more often with LAMA than asthma patients. In the US databases treatment for asthma and COPD are comparable and systemic steroids are frequently used as first treatment. ACO patients most often receive treatment and differences are smaller between US and Europe.

Conclusions: We conclude that treatment patterns vary across countries with substantial differences in first treatments.