Prescription Status and Clinical Outcomes of Methylxanthines and Leukotriene Receptor Antagonists in Mild-to-Moderate Chronic Obstructive Pulmonary Disease

Abstract

Background

Methylxanthines and leukotriene receptor antagonists (LTRA) are not a first-line medical treatment for chronic obstructive pulmonary disease (COPD) but are frequently prescribed despite limited evidence. We aimed to elucidate the real prescribing status and clinical impacts of these agents in early COPD patients.

Methods

Patients with mild-to-moderate COPD (FEV₁>50%) were selected from the Korean National Health and Nutrition Examination Survey data between 2007 and 2012. Besides analyzing the prescription status of methylxanthines and LTRA and the contributing factors to the prescription, we evaluated the clinical impacts of these drugs on the exacerbation, hospitalization, and medical costs.

Results

Of 2269 patients with mild-to-moderate COPD, 378 patients (16.7%) were under medical treatments, and the users of methylxanthines and/or LTRA were 279 patients (12.3%); however, only 139 patients (6.1%) were inhaler users. The contributing factors for the prescription of methylxanthines were a comorbidity of asthma or allergic disease, poor lung function, low quality of life, prescribing doctor from the specialty of internal medicine, and an institution type of private hospital. The prescription of LTRA was associated with the comorbidity of allergic disease. The methylxanthine and/or LTRA users had more hospital utilization but did not have significant differences in acute exacerbations and medical cost for hospital utilization, compared with the non-users.

Conclusion

Methylxanthines and LTRA were used in a significant proportion of patients with mild-to-moderate COPD in real fields without favorable impacts on the exacerbations, hospitalizations, or medical costs. The use of more effective inhaled medications should be encouraged.

Keywords:

• pulmonary disease
• chronic obstructive
• methylxanthine
• leukotriene antagonists
• drug prescriptions

Acknowledgments

The abstract of this paper was presented at the American Thoracic Society Conference 2019 as a poster presentation on May 20, 2019 with interim findings. The poster’s abstract was published in “Poster Abstracts” in American Journal of Respiratory and Critical Care Medicine (Am J Resp Crit Care Med 2019;199:A3298; https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A3298).

Abbreviations

COPD, chronic obstructive pulmonary disease; LTRA, Leukotriene receptor antagonists; KNHANES, Korean National Health and Nutrition Examination Survey; FEV_1, forced expiratory volume in the first second; HIRA, Health Insurance Review and Assessment; EQ-5D, EuroQol-5 dimension; aOR, adjusted odds ratio; CI, Confidence interval; GOLD, Global Initiative for Obstructive Lung Disease.

Author Contributions

All authors contributed toward data analysis, drafting and revising the paper, gave final approval of the version to be published and agree to be accountable for all aspects of the work. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Disclosure

C.K.R reports personal fees from MSD, AstraZeneca, GSK, Novartis, Takeda, Mundipharma, Boehringer-Ingelheim, Teva, and Bayer, outside of the submitted work. The authors report no other conflicts of interest in this work.