Less than 3% of patients who had pulmonary hypertension associated with chronic obstructive pulmonary disease (PH-COPD) received medications for pulmonary arterial hypertension (PAH). Although 68.4% of these patients used medications for COPD, this amount fell short of the recommended level. These were among study findings reported in BMC Pulmonary Medicine.
PH-COPD is a subgroup of Group 3 PH. The underlying COPD can be treated with inhaled bronchodilators and inhaled corticosteroids, and current guidelines recommend that all such patients receive optimized COPD medication therapy. However, no PH medications are approved for PH-COPD, and there is insufficient evidence supporting PAH-targeted therapies in patients with PH-COPD. Investigators therefore undertook an analysis of administrative claims data to identify and characterize medications used by patients with COPD with PAH.
Investigators first developed an algorithm to identify adult patients with PH-COPD, based on diagnostic codes. Of the 263,600 patients with a PH diagnosis identified in the Optum Clinformatics Data Mart database between January 2009 and September 2019, 25,975 (9.9%) met the criteria for PH-COPD (ie, had a least 2 diagnostic codes for PH and COPD). Patients had a mean age of 73.5 years; 63.8% were female; 78/7% had comorbid systemic hypertension; 64.7% had comorbid asthma; and 42.7% had comorbid coronary artery disease.
Medications for PAH were prescribed to 643 (2.5%) patients with PH-COPD; the most frequently used of these medications were a phosphodiesterase type 5 (PDE5) inhibitor (used by 2.1% of patients with PH-COPD) and endothelin receptor antagonist (used by 0.75%). Medications for COPD were prescribed to 17,765 (68.4%) patients with PH-COPD. The most frequently used medications were an inhaled corticosteroid (used by 57.4% of patients with PH-COPD) and short-acting beta agonist (used by 50.4%). Median durations of medication use were 0.4 months to 5.9 months for COPD medications and 4.9 months to 12.8 months for PAH medications.
Among the 25,975 patients with PH-COPD, 2325 (8.95%) had a right-heart catheterization (RHC). Of these patients 257 (11.1%) used PAH medications, most frequently a PDE5 inhibitor (83.3%), whereas 1670 (71.8%) patients used COPD medications, most commonly an inhaled corticosteroid (83.4%) or short-acting beta agonist (72.0%).
A pulmonary function test was performed in 11.5% of patients with PH-COPD. Of these 2995 patients with PH-COPD, 58 (1.9%) used PAH medications, and 2100 (70.1%) used COPD medications.
Study limitations include: lack of disease severity information; the absence of test results; potential coding errors or bias; enrollment turnover; and possible off-label use of PAH medications.
“Most patients (two-thirds) received medications recommended for COPD, which is a lower rate than expected from guidelines, while fewer than 3% of patients received medications targeting PAH, which is largely consistent with the absence of any recommended pharmacotherapy for PH in patients with PH-COPD,” the investigators concluded.
Disclosure: Funding for this study was provided by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co, Inc. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Weiss TJ, Ramey DR, Yang L, et al. Medication use by US patients with pulmonary hypertension associated with chronic obstructive pulmonary disease: a retrospective study of administrative data. BMC Pulm Med. 2022;22(1):383. doi:10.1186/s12890-022-02167-9