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A4995 - Burden of Symptoms Among Patients with COPD on LAMA Monotherapy
Author Block: B. Hahn1, R. Stanford1, A. Hunter2, B. Essoi2, J. White2, R. Ray3; 1GlaxoSmithKline, Research Triangle Park, NC, United States, 2Optum, Eden Prairie, MN, United States, 3GSK, Durham, NC, United States.
Rationale: Long-acting muscarinic antagonists (LAMA) are the most prescribed bronchodilators for treatment of COPD. However, patients on LAMA monotherapy may still need additional symptom control via another bronchodilator as recommended by the 2017 GOLD strategy document. This study sought to assess symptom burden in patients treated only with LAMA monotherapy in a managed care setting.
Methods: Patients aged ≥40 years with ≥2 ICD-10-CM diagnosis codes for COPD and ≥2 claims for LAMA monotherapy were identified from a large, geographically diverse US health plan from October 1, 2015 to September 30, 2016. Patients were invited by mail to participate by completing a survey containing questions on general health and well-being, current COPD treatment, smoking history, sociodemographic characteristics and three patient-reported outcome (PROs) measures. PROs comprised the COPD Assessment Test (CAT), Modified Medical Research Council Dyspnea scale (mMRC), and Exacerbations of Chronic Pulmonary Disease Tool (EXACT); the latter via a 7-day daily diary. For PROs reported here, higher scores indicate higher burden/symptom severity. Survey data and administrative claims data for the 12-month baseline were combined for analysis. Results: A total of 2,275 patients met eligibility criteria and were invited to participate in the study. 528 patients completed the survey (29.8% response rate); the final evaluable sample included 433 patients on LAMA monotherapy with claims-linked survey and diary data. Patients averaged 71 years of age (SD±9.4); 35% were ≥75 years. Approximately 60% were female; nearly all were Medicare Advantage enrollees (88%). With regard to symptom severity, the mean CAT score was 18.46 (±8.41) with the majority of the sample (85%) scoring ≥10, and 39% with scores ≥21. Almost half (46%) reported high levels of dyspnea (mMRC grade 2-4). Nearly two-thirds (64%) had more severe daily symptoms than average on at least one of seven days as measured by the EXACT. Over one third (36%) reported severe symptoms/symptom burden on all three PRO measures. In contrast, only 12% of participants had low scores on all PRO measures, indicating fewer symptoms. Conclusions: Study results demonstrate that a large portion of patients with COPD who are treated with LAMA monotherapy remain symptomatic based on patient-reported burden of illness measures including the CAT, mMRC, and EXACT. These patients may need additional therapy or adherence counseling to reduce this symptom burden. Physicians should consider including questions or tools to measure symptom impact as part of routine visits for patients with COPD.