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Lutter, J. ; Jörres, R.A.* ; Trudzinski, F.C.* ; Alter, P.* ; Kellerer, C.* ; Watz, H.* ; Welte, T.* ; Bals, R.* ; Kauffmann-Guerrero, D. ; Behr, J.* ; Holle, R.* ; F Vogelmeier, C.* ; Kahnert, K.*

Treatment of COPD Groups GOLD A and B with inhaled corticosteroids in the COSYCONET cohort - determinants and consequences.

Int. J. Chron. Obstruct. Pulmon. Dis. 16, 987-998 (2021)
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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: 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: 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: 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.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Copd ; Gold Groups ; Inhaled Corticosteroids ; Overtreatment
ISSN (print) / ISBN 1176-9106
e-ISSN 1178-2005
Quellenangaben Volume: 16, Issue: , Pages: 987-998 Article Number: , Supplement: ,
Publisher Dove Medical Press
Publishing Place Albany, Auckland
Reviewing status Peer reviewed
Grants Pfizer Pharma GmbH
German Center for Lung Research (DZL)
AstraZeneca GmbH
Bayer Schering Pharma AG
Boehringer Ingelheim Pharma GmbH Co. KG
Chiesi GmbH
Grifols Deutschland GmbH
MSD Sharp Dohme GmbH
Mundipharma GmbH
Novartis Deutschland GmbH
Takeda Pharma Vertrieb GmbH Co. KG
Teva GmbH
German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET)