Characterization of GOLD E COPD patients in the United States

A significant number of COPD patients suffer from high exacerbation burden. We retrospectively identified patients from the Optum Market Clarity database in the US (Jan 2016 – Dec 2021), who had 3 consecutive calendar years of data (unless they died). Patients were 40-80 years of age at Year 1 (baseline year), continuously enrolled in a health plan, and had a diagnosis of COPD. They were stratified into GOLD E (if ≥2 moderate or ≥1 severe COPD exacerbation(s)) and non-GOLD E cohorts based on exacerbation history at baseline year. Of the 145,357 COPD patients identified, 38,507 (26.5%) were GOLD E at baseline year: mean (SD) age was 65.3 (9.3) years; 59% female; 14% African American; 2.4% Hispanic. Compared to non-GOLD E patients, 106,850 (73.5%), GOLD E patients had significantly higher comorbidity burden at baseline year: hypertension (86% vs 79%), coronary artery disease (49% vs 37%), heart failure (44% vs 23%), myocardial infarction (11% vs 4%) (all p<0.001). In baseline year, 65% of GOLD E patients had ≥1 severe COPD exacerbation; 60% had ≥1 moderate COPD exacerbation. 37% of GOLD E patients died in Years 2 or 3 (non-survivors; n=14,089). GOLD E non-survivors were less likely than GOLD E survivors (survived all 3 years) to be on ICS/LABA (41% vs 48%), LAMA/LABA (6% vs 8%), or ICS/LABA/LAMA inhaler (19% vs 23%) at baseline year (all p<0.001). Our study provides further characterization of a GOLD E COPD population in the US from a large generalizable claims database. Our findings highlight the unmet needs, given the poor outcomes seen in GOLD E patients. Newer therapeutic and non-therapeutic approaches may be needed to reduce disease burden in GOLD E COPD patients.