Does Dosage Frequency Matter for Adherence to Anticholinergic Treatment in Patients with COPD?
A study by Spanish authors compared the adherence of patients with chronic obstructive pulmonary disease (COPD) to anticholinergic treatment administered once every 12 hours and once every 24 hours.
Adherence to Treatment in Studies vs. Practice
COPD requires regular use of maintenance therapy, which often includes long-acting anticholinergics (LAMA). For patients to truly benefit from this treatment, proper adherence is essential; otherwise, the risk of poor clinical compensation, exacerbations, and hospitalizations increases. Unfortunately, adherence to therapy in clinical studies varies significantly from real clinical practice (70–90% vs. 10–40%).
Methodology of Analysis
The authors of the presented work were interested in whether dosing LAMA once daily would improve adherence compared to twice-daily dosing. For this purpose, they analyzed data from a total of 16,446 patients from the Spanish region of Castile-La Mancha, who were prescribed LAMA between January 1 and December 31, 2013. The follow-up period for patients was extended to December 2014 using a centralized electronic prescription system. The LAMAs available on the Spanish market include tiotropium (HandiHaler and Respimat), aclidinium, and glycopyrronium.
Adherence was considered good if the ratio of doses dispensed by the pharmacy to the number of days they should last according to the product summary (or the proportion of days covered – PDC) was greater than 0.8.
Results
In the analyzed population (76.4% men; average age 74.2 years), adherence to treatment was very high (80–120%). It was found that during the follow-up period, 7.4–10.7% more medication was dispensed (similarly for all LAMAs) than would have been sufficient according to the SPC. It is assumed that doses were taken more frequently than prescribed by the doctor, or there was a loss of capsules containing the inhalation medication.
Seasonal variations in LAMA consumption were not observed, nor was there a difference between adherence to medications taken once daily (every 24 hours) and twice daily (every 12 hours), between different molecules, or between different types of inhalers used for the same medication. Most patients used tiotropium (n = 15,252), significantly fewer used aclidinium (n = 909) or glycopyrronium (n = 285). PDC values were comparable for all medications: 1.10 (standard deviation [SD] 0.32; tiotropium) and 1.07 (SD 0.29; both aclidinium and glycopyrronium). The results were similar during the follow-up in 2014.
Conclusion
Adherence to treatment in the monitored area is very high across all available medications. The authors did not observe that patients taking LAMA twice daily had lower adherence compared to once-daily dosing.
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Source: Izquierdo J. L., Paredero J. M., Piedra R. Relevance of dosage in adherence to treatment with long-acting anticholinergics in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11 (1): 289–293, doi: 10.2147/COPD.S96948.
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