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

Table of contents

  • Chronic Obstructive Pulmonary Disease - Current Treatment - Detailed, Expanded Analysis (EU5)
    • Key Updates
      • November 2017
        • August 2017
        • Introduction to Current Treatment for COPD
          • Key Findings
          • Summary Figures
            • Current Prescribing of COPD Therapies, by Class
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: EU5 Total
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: EU5 Total
          • Introduction to Current Treatment and Medical Practice for COPD
          • Drugs Included in This Study of Current Treatment of COPD
        • Physician Prescribing Practices
          • Key Findings
          • Patient Characteristics
            • Pulmonologists Report Generally Equal Distribution of COPD Severity in the EU5
            • Distribution of Disease Severity Among Surveyed Pulmonologists' COPD Patients
            • Prevalence of Subpopulations Among Surveyed Pulmonologists' COPD Patients
          • Treatment Practices
            • Most Patients Receive Long-Acting Therapy; Combinations Are Preferred
            • Size of Surveyed Pulmonologists' Practices
            • Number of Extended-Care Providers in Surveyed Pulmonologists' Practices
            • All COPD Patients in the EU5 Receive Treatment Within 100 Days of Diagnosis
            • Average Length of Time Between Initial Diagnosis and Treatment Initiation
            • The Majority of GOLD B/C/D Patients Receive a Long-Acting Therapy
            • Patients Receiving Short- and Long-Acting Treatments, by Severity
            • Monotherapy Is Preferred for GOLD Grade A/B and Combinations for GOLD C/D
            • Current Prescribing of Short-Acting Therapies, by Severity
            • Current Prescribing of Long-Acting Therapies, by Severity
            • Current Prescribing of LAMAs, by Severity
            • Current Prescribing of Select LABA/ICS FDCs, by Severity
            • Current Prescribing of LABA/LAMA FDCs, by Severity
            • Prescribing Scenarios for Generic LABA/ICS FDCs
            • Use of Short-Acting Therapies Increases as the Severity of COPD Increases
            • Number of Days of Short-Acting Treatment
            • Smoking Cessation, PT, and Pulmonary Rehab Are Often Used in COPD
            • Nonpharmacological Treatment of COPD
            • Triple Therapy Is Used Late but Reaches Only Half of GOLD C/D Patients
            • A Majority of COPD Patients Are on First- or Second-Line Therapy
            • Current Treatment Rates by Line of Therapy
            • Pulmonologists Are Likely to Try Additional Combination Therapies
            • Treatment Duration by Line of Therapy
            • Trial of Additional Therapies Within a Class
            • LABA/LAMAs Have Become the Preferred Therapy for Many COPD Patients
            • Patient Share by Line of Therapy, GOLD A/B Patients
            • Patient Share by Line of Therapy, GOLD C/D Patients
            • Current Triple-Therapy Use, by Severity
            • Open Triple-Therapy Combinations, by Severity
          • Persistency and Compliance
            • Persistency and Compliance Are High for Long-Acting Therapies
            • Patient Compliance with Select Therapies
            • Reasons Patients Are Not Compliant with Prescribed Therapies
            • Patients Discontinued on LAMAs Within One Year, by Product
            • Patients Discontinued on LABA/ICS FDCs Within One Year, by Product
            • Patients Discontinued on LABA/LAMA FDCs Within One Year, by Product
          • Sequencing of Treatment
            • Patients Switched to Triple Therapy Come from Other Combination Therapies
            • Changes in Treatment Regimen Upon Failure, by Class
            • Pathways to Initiation, by Class: France
            • Pathways to Initiation, by Class: Germany
            • Pathways to Initiation, by Class: Italy
            • Pathways to Initiation, by Class: Spain
            • Pathways to Initiation, by Class: United Kingdom
            • Pathways to Initiation, by Class: EU5 Average
          • Recent/Anticipated Changes in Brand Use/Treatment Approach
            • Newer Therapies Are Gaining Patient Share
            • Pulmonologists' Responses to the GOLD Guideline Endorsement of LABA/LAMA FDCs
            • Pulmonologists' Change in Use of LABA/ICS FDCs in the Past Six Months
            • Pulmonologists' Change in Use of LABA/LAMA FDCs in the Past Six Months
            • Pulmonologists' Change in Use of LAMAs in the Past Six Months
            • Pulmonologists' Anticipated Change in Use of LABA/ICS FDCs in the Next Six Months
            • Pulmonologists' Anticipated Change in Use of LABA/LAMA FDCs in the Next Six Months
            • Pulmonologists' Anticipated Change in Use of LAMAs in the Next Six Months
            • Current and Anticipated Future Product Share in the LABA/LAMA Class
        • Physician Insight on Medical Practice
          • Key Findings
          • Drivers of Treatment Selection
            • Efficacy and Safety Drive LABA/LAMA Prescribing and Impede LABA/ICS Use
            • Patient Preference and Ease of Use Drive Choice of Device
            • Factors Influencing Device Selection
            • Brand Selection Is Often Driven by Efficacy, but Device Also Matters
            • Factors Driving Treatment Choice Within the LAMA Class: France
            • Factors Driving Treatment Choice Within the LAMA Class: Germany
            • Factors Driving Treatment Choice Within the LAMA Class: Italy
            • Factors Driving Treatment Choice Within the LAMA Class: Spain
            • Factors Driving Treatment Choice Within the LAMA Class: UK
            • Factors Driving Treatment Choice Within the LAMA Class: EU5 Total
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: France
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: Germany
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: Italy
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: Spain
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: UK
            • Factors Driving Treatment Choice Within the LABA/ICS FDC Class: EU5 Total
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: France
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: Germany
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: Italy
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: Spain
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: UK
            • Factors Driving Treatment Choice Within the LABA/LAMA FDC Class: EU5 Total
            • Devices Often Depress Prescribing, Side Effects Impact LABA/ICS FDCs
            • Major Obstacles to LAMA Use
            • Major Obstacles to LABA/ICS FDC Use
            • Major Obstacles to LABA/LAMA FDC Use
            • Efficacy and Lack Thereof Drive Therapy Switching and Discontinuation
            • Most Common Reason for Switching to LAMA Therapy
            • Most Common Reason for Switching to LABA/ICS FDC Therapy
            • Most Common Reason for Switching to LABA/LAMA FDC Therapy
            • Most Common Reason for Discontinuing COPD Therapy, by Class
        • Methodology
          • Primary Market Research Methodology
          • Number of Surveyed Pulmonologists
          • Distribution of Surveyed Pulmonologists, by Country
          • Distribution of Years in Practice Since First Qualifying as a Pulmonologist, by Country
          • Distribution of Number of Patients Diagnosed with COPD Under Personal Management, by Country
          • Percentage of Pulmonologists Prescribing Major Drug Classes for COPD, by Country
        • Appendix
          • Primary Market Research
            • Use of Long-Acting Therapy in COPD, Asthma, and Other Respiratory Conditions
            • Current Severity Distribution of ICS Use
          • Bibliography

      Author(s): Kristine Mackin, PhD

      Kristine Mackin, Ph.D., is an analyst on the immune and inflammatory disorders team at Decision Resources Group. She currently focuses on respiratory diseases, including asthma and COPD.

      She holds a doctorate in biochemistry from Brandeis University, where she studied the evolution of bacteriorhodopsin and the relationship between type I and type II rhodopsins. During her B.A. in Chemistry at Carleton College, she researched proinsulin processing. Prior to joining DRG, Dr. Mackin was involved with literature and market research for a new company pitch during an internship at Puretech Ventures in Boston, MA.


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