Biological Anti-IL-5/IL-5R Therapeutics for Chronic Obstructive Pulmonary Disease (COPD) with Specific Treatable Traits: A Real-World Retrospective Analysis

Introduction

We describe the use of anti-IL-5 monoclonal antibodies from a COPD clinic, a source other than traditional clinical trials. The objectives were to characterize the patient subgroup prescribed anti-IL-5 monoclonal antibodies and to report potential benefits.

Methods

This is a retrospective case series study of 17 patients treated in a COPD subspecialty clinic. All patients had a diagnosis of COPD (post-bronchodilator FEV1/FVC <0.7) and had been prescribed an anti-IL-5 biologic for at least 8 months. Acute exacerbations of COPD (AECOPDs) were collected as reported in electronic medical records.

Results

All patients (17) enrolled were treated with biologics for ≥8 months, and 13 (76%) for ≥1 year. Patients were characterized by severe disease traits, FEV1 <50% predicted, recurrent exacerbations (3.5 moderate-to-severe AECOPDs in the year before treatment), high peripheral blood eosinophil counts (≥250 cells/μL in the previous year), all on inhaled triple therapy, and only 1 patient with a diagnosis of asthma prior to smoking. There was a statistically significant decrease in the exacerbation rate compared with baseline after 8 and 12 months of anti-IL-5 treatment, respectively, yielding the equivalent of a 2-3x reduction in exacerbation rate. Absolute FEV1 decreased, and the decline in FEV1 % of predicted reached statistical significance (p<0.05); CAT score improved (p<0.05).

Discussion

This real-world evidence data aligns with existing studies suggesting the potential benefit of anti-IL-5 treatment for specific patients with COPD and therefore advocates for further investigation of RCTs on the use of anti-IL-5 biologics for well-characterized patients with COPD.

Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence

Introduction

Self-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic.

Methods

Initially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients’ behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases.

Results

Thirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, p<0.001) and with ≥1 COPD-related hospitalisations (75 before vs 65 after enrolment, p<0.001).

Discussion

COPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations.

Trial registration number

NCT02275078.

Making collaborative self-management successful in COPD patients with high disease burden

BACKGROUND

Exacerbations in severe COPD patients lead to challenges in terms of self-management. This study is a "real-life" situation aiming to assess whether or not it is possible for COPD patients with high burden of disease to self-manage acute exacerbations and to reduce hospital use.

METHODS

100 randomly selected charts of patients followed in a specialised COPD clinic in 2006 and 2009 (patients with higher burden of disease) were reviewed. Data on patients' characteristics, COPD severity and exacerbation management were extracted.

RESULTS

Compared to the 2006 cohort, patients from the 2009 cohort had lower (0.85 L), but not statistically significant different FEV1 (L) than the 2006 cohort (0.98 L) and more exacerbations (2.6 exacerbations/pt vs 3. 6 exacerbations/pt, p = 0.03). Despite having a higher burden of disease, patients in the 2009 cohort as compared to 2006 had more appropriate self-management behaviours in the event of an exacerbation (60% vs 42%, p = 0.05) and fewer emergency room visits and/or hospital admissions (39% vs 57%, p = 0.02). There were more phone calls to the case managers (590 vs 382, p < 0.001) and fewer physician office visits (167 vs 179, p = 0.024).

CONCLUSIONS

This study of a real life situation adds to the current body of literature that a more severe COPD patient population can be taught self-management skills in the event of exacerbations, leading to fewer health care visits and hospital admissions.

A Model Applied to a Real Life Situation: Self-Management with a Written Action Plan for Early Treatment of COPD Exacerbations

Background: We hypothesized that self-management education with the use of a written action plan provided by a nurse case manager can help patients to gain the proper skills to start an early treatment for an acute exacerbation. Methods: COPD patients from an outpatient clinic with access to a written action plan and self-administered prescription were instructed to initiate their antibiotics and/or prednisone in case of exacerbation, and call their nurse case manager for supervision. The following data was collected: symptoms change, patients delay in taking action to treat their exacerbations (starting antibiotics and prednisone, calling the case manager) and use of hospital services. Results: We report on 187 exacerbations occurring in a cohort of 113 moderate / severe COPD patients with FEV1 of 37 ± 16% predicted (mean ± SD). 161 exacerbations were supervised by the case manager at the time of the event. The remaining 26 exacerbations were detected after the event. 87% of the supervised exacerbations presented with 2 major symptoms (increased dyspnea, increased sputum volume and/or purulent sputum). Patient’s delay to initiate treatment in supervised exacerbations was 2.04 ± 1.8 days; 85% took action to treat the exacerbation within 3 days. The treatment for supervised and unsupervised exacerbations was similar (slightly more antibiotics and prednisone were used for unsupervised ones) and they had similarly favourable outcomes in terms of health services use, with 68.5% of the exacerbations not requiring any hospital services. Conclusions: Patients can take an active role, acquire the skills to recognize exacerbation symptoms and start an early treatment of antibiotics and prednisone according to the directives of their written action plan.