Chronic Obstructive Pulmonary Disease | Current Treatment | EU5 | 2017

Most patients with chronic obstructive pulmonary disease (COPD) in the five European countries under study receive treatment shortly after diagnosis. The progressive nature of the disease results in many patients eventually needing combination therapy, and those at higher risk of exacerbations must often take maximal inhaled therapy—i.e., a combination of a long-acting beta2 agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS). The reasons why surveyed pulmonologists select a particular therapy or combination reveal trends in drug use for COPD, especially the changing uptake of ICSs and LABA/LAMA fixed-dose combinations (FDCs). Efficacy is naturally an important driver of therapy selection, but other end points are used in clinical trials as well, and our survey results reveal which therapies pulmonologists believe will sustain improvements over the long term.

Questions Answered:

The emergence of LABA/LAMAFDCs and their performance in clinical trials measuring the frequency of exacerbations are changing prescribing for COPD. How does the current use of LABA/LAMAFDCs differ between patients with more- or less-severe disease? How is use of LABA/ICSFDCs shifting across the EU5? Which therapies within the class are preferred and why?·

Many COPD patients require a combination of therapies to control daily symptoms and prevent exacerbations. How many patients receive both short- and long-acting therapy? What combinations are used most often, and how are these combinations sequenced within chronic treatment for COPD? How many patients currently receive open triple combinations?

COPD often requires escalating therapy to control the disease, but patients may try several therapies within a drug class before switching. For how long do patients typically receive their prescribed LAMA, LABA/ICSFDC, or LABA/LAMAFDC, and for what reasons do they discontinue these treatments? Are patients more or less compliant with once-daily versus twice-daily therapies? What factors influence compliance?

Scope:

Markets covered: France, Germany, Italy, Spain, and the United Kingdom

Methodology: Surveys of 250 pulmonologists completed in February 2017.

Indication coverage: Chronic obstructive pulmonary disease

Key drugs covered: Spiriva, Eklira/Bretaris, Incruse, Seebri, Seretide, Symbicort, Relvar, Foster/Formodual, Anoro, Ultibro, Duaklir, Spiolto

Key companies mentioned: Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Novartis, Innoviva, Chiesi