A44-12 Real-world Treatment Patterns After Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: Assessing Subsequent COPD Exacerbation in the United States

Abstract Rationale To describe the real-world treatment patterns in patients hospitalized for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD and to assess subsequent COPD exacerbations in the 12-month follow-up period in a United States population. Methods A retrospective cohort analysis was conducted using Optum® Market Clarity data including patients ≥40 years old who received inhaled maintenance treatment of long-acting muscarinic antagonist (LAMA) and/or long-acting β2-agonist (LABA), with or without inhaled corticosteroids (ICS), and were hospitalized with an AECOPD between January 1, 2022, and December 31, 2024. The first observed AECOPD hospitalization was the index event; date of discharge was the index date. Baseline demographics, clinical characteristics, and maintenance therapy were assessed in the 12-month period prior to the index event using descriptive statistics. Proportions of patients with subsequent COPD exacerbations (defined by GOLD 2025 guidelines) were assessed in the 12-month follow-up period after the index date; analyses of maintenance therapies were performed on the overall patient sample and stratified by blood eosinophil count (BEC) status. Results Population characteristics are shown in the table and include patients hospitalized with AECOPD who received long-acting bronchodilators (LA-BD; LAMA and/or LABA) prehospitalization (N = 48,476). Treatment pattern for patients on ICS prehospitalization (82%; 39,895/48,476), including LAMA or LABA monotherapy plus ICS (33%; 15,766/48,476) and LAMA+LABA dual therapy plus ICS (triple therapy; 50%; 24,129/48,476) showed that 92% of these patients re-initiated an outpatient prescription for an ICS within 60 days post-discharge. For patients not on ICS pre-hospitalization (n = 8,581), only 30% (1,141/3,771) of those on prior LAMA or LABA monotherapy, and 20% (961/4,810) of those on prior LABA+LAMA dual therapy initiated new ICS treatment within 60 days post-discharge. During the pre-index period, 18,803 (39%) patients had a BEC available. In contrast to GOLD guidelines recommendations, BEC distributions were similar between patients prescribed ICS versus those not prescribed ICS. Among patients on LA-BD plus ICS pre-hospitalization who continued ICS post-hospitalization (n = 36,583), 50% (7,109/14,209) with LAMA/LAMA mono + ICS use and 58% (12,913/22,374) with LABA/LAMA/ICS triple therapy had at least one COPD exacerbation in the 12-month follow-up period. When ICS was added to LABA+LAMA dual therapy post-discharge, 58% (557/961) of patients had ≥1 COPD exacerbation in the 12-month follow-up. Conclusions Proportion of patients experiencing follow up COPD exacerbations were substantial and did not vary considerably based on the maintenance regimen. GOLD guideline recommendations should be used to inform the use of ICS for managing COPD in clinical practice. This abstract is funded by: This study was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.