Posters Provide Evidence on COPD Treatment Considerations, Exacerbation Risk Assessment

Chronic obstructive pulmonary disease (COPD) management should balance reducing the number and severity of exacerbations and the likelihood of treatment failure with the health risks of systemic corticosteroids (SCS), according to a poster presented at the Academy of Managed Care Pharmacy Nexus 2021 meeting, which occurred October 21-28 in Denver, Colorado. Another poster presented at the conference validated the use of the COPD treatment ratio (CTR) as a measure of exacerbation risk within a large commercial and Medicare population.

The first poster examined comorbidities of COPD in a Medicare patient sample and the use patterns of SCS.¹ SCS are often prescribed for COPD exacerbations and are sometimes prescribed in chronic maintenance therapy for COPD. However, SCS use has many known complications, including osteoporosis and diabetes, the poster authors wrote.

Utilizing the 2013-2019 Medicare 100% fee-for-service (FFS) database, the researchers examined all FFS patients 40 years and older who received a new diagnosis of COPD in 2015. The patients had no history of SCS use within 24 months prior to the COPD diagnosis.

The results were compared with members with continuous Medicare Part A, B, and D enrollment from 2013-2015.

They identified 183,637 newly diagnosed COPD patients with no recent history of SCS use in 2015. Twenty-eight percent had cardiovascular disease, 15% had peripheral arterial disease, and 32% had depression/anxiety.

Within 4 years of their COPD diagnosis, 36% were treated with oral SCS.

FFS patients with incident COPD had a variety of comorbidities at the time of their COPD diagnoses, the presenters said. Compared with the sample of FFS beneficiaries, the COPD patients were younger with higher rates of select comorbidities, and many were prescribed oral SCS after their COPD diagnosis.

“Due to an aging population and the possible complications of SCS treatment, the management of COPD should be proactive in balancing treatment goals around reducing the number and severity of exacerbations and the likelihood of treatment failure with the health risks of SCS exposure,” the authors concluded.

In the second poster, presenters examined the COPD Treatment Ratio (CTR), the ratio of controller medications to all COPD medications, in commercial and Medicare populations.²

“Incremental increases in CTR have been associated with reductions in risk of severe COPD exacerbations,” the presenters wrote. CTR has potential as a surrogate marker of COPD exacerbation risk, but they aimed to conduct additional validity testing “to improve the robustness, transparency, and applicability of the methods for quality measurement purposes.”

Their retrospective cohort study used administrative claims from OptumLabs Clinformatics Data Market from 2016 to 2019. They examined CTR values and exacerbation risk factors (age, exacerbation, history, COPD, and concomitant medication use) over 12 months. Eighty percent of the 224,3024 patients were enrolled in Medicare Advantage and the mean age was 69.5 years.

The CTR was “significantly associated” with a reduced risk of any, moderate, and severe exacerbations in the total population, the investigators found. CTR also performed fair to moderately well in producing exacerbation risk (C-statistics ranged from 0.668 to 0.771), and performed the best in predicting severe exacerbations.

The authors noted that their findings support the use of CTR in quality measures, although further study around the measure specifications may be needed.

References

1. Sethi S, Pollack M, Feigler N, et al. A multi-year retrospective analysis of comorbidities potentially sensitive to corticosteroid exposure within an incident COPD and a Medicare sample population. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Poster J7.

2. Campbell P, Parikh M, Burbage S. Validation of the COPD treatment ratio in a commercial and Medicare population. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Poster J10.