Real-world retrospective database analysis of COPD exacerbations before and during the COVID-19 pandemic in Europe (REACT)

Abstract

Introduction: Several studies have reported a decline in the number of acute exacerbations of COPD (AECOPD) during the COVID-19 pandemic in 2020-21, likely a result of mask-wearing and social distancing. Clinical trials designed to assess the effect of therapeutic interventions on rates of AECOPD are usually enriched with a population having documented AECOPD during the prior year and thus may be impacted by this phenomenon.

Objective: To quantify patients experiencing AECOPD during the COVID-19 pandemic, informing the feasibility of upcoming trials in Europe.

Methods: A retrospective real-world data cohort analysis using IQVIA E360^® was conducted on electronic medical records collected from France, Germany, Italy, and the UK. Patients with AECOPD were selected by a validated algorithm (Rothnie K.J. et.al. PLoS ONE 2016;11:e0151357). The proportion of patients with AECOPD were calculated for pre-COVID (Jan 2017-Dec 2019) and COVID periods (Jan 2020-Dec 2020).

Results: Compared with 2019, the proportion of patients with AECOPD decreased in 2020 by an absolute 17-53% (45% to 28% in Germany, 51% to 27% in France, 63% to 17% in Italy, and 67% to 14% in the UK). In each country, the seasonal exacerbation pattern was no longer seen in 2020. Also, in Italy, France, and the UK, more patients filled prescriptions for maintenance COPD treatment during the pandemic than before.

Conclusions: The proportion of patients with AECOPD were substantially decreased during the pandemic with flattening of the seasonal pattern. These findings are likely to have a significant impact on the feasibility of enrichment strategies in clinical trials initiated in Europe in 2021.