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Exacerbation history is a reliable predictor of future exacerbations

Presented By
Prof. Claus Vogelmeier, Philipps University of Marburg, Germany

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Conference
ERS 2020
Trial
Cohort study, AvoidEx
Previous exacerbations proved an important risk factor for future exacerbations. This real-world data from a large cohort study supports the need for improved management and treatment of COPD patients [1].

In the registry-based, cohort study AvoidEx, data was collected from German healthcare insurance claims and Swedish medical records of COPD patients ≥40 years. All participants had their first COPD diagnosis during 2010-2017. Overall, 250,723 COPD patient from Germany and 27,178 COPD patients from Sweden were included. Patients were divided into 4 groups (i.e. none, 1 moderate, 1 severe, ≥ 2 moderate to severe) according to the baseline exacerbation 12 months pre-index (which is based on the exacerbation classification). The follow-up period lasted up to 9 years.

In German patients without baseline exacerbations, 19.0% (18.9-19.2%) had exacerbations after 1-year follow-up and 35.9% (35.7-36.1%) after 3 years. In Sweden, corresponding numbers were 22.5% (21.9-23.1%) and 39.4% (38.7-40.1%), respectively. After 3 years, cumulative exacerbation risk was 59.1% (58.5-59.7%), 58.1% (56.1-60.1%), and 84.1% (83.6-84.5%) in German patients with 1 moderate, 1 severe, and ≥2 moderate-to-severe exacerbations at baseline, respectively. Corresponding numbers in the Swedish population were 53.6% (51.7-55.5%), 66.6% (62.6-70.7%), and 84.1% (82.8-85.4%), respectively (see Figure). “As you can see, there is a stepwise increase: patients who had a lower exacerbation rate in the past had a lower risk of exacerbations in the future and the risk goes up depending on the exacerbation history,” explained Prof. Claus Vogelmeier (University Clinic Giessen and Marburg, Germany).

Figure: Results show that patients with previous exacerbations have a much higher risk of future exacerbations [1]



In total, more than 1 out of 3 patients without baseline COPD exacerbation experienced exacerbation(s) during the 3-year follow up. In addition, more than half of those with 1 moderate baseline exacerbation experienced subsequent exacerbation(s), with an even higher risk in patients with frequent or severe baseline exacerbations. Yet, even patients with only 1 moderate baseline exacerbation had more subsequent exacerbations compared with those without baseline exacerbations. Patients with no history of exacerbations had also a much longer time until the next subsequent exacerbation during follow-up.

“I think this data very nicely supports earlier data under very different circumstances, because this data used medical data and insurance data from a very big cohort. But all this information stresses that exacerbation history is a self-fulfilling prophecy for future events,” Prof. Vogelmeier concluded.

 


    1. Vogelmeier C. Risk of future exacerbations among COPD patients – A real-world register-based cohort study (AvoidEx). Abstract 4189, ERS International Virtual Congress 2020, 7-9 Sept.

 



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