Posters Reveal Early COPD Treatment Benefits, Highlight Superior Adherence With Single-Inhaler Triple Therapy

Two posters presented at the CHEST 2024 annual meeting found that both earlier identification of patients with chronic obstructive pulmonary disease (COPD) at risk of exacerbation and earlier initiation of the appropriate initial pharmacological treatment (IPT) is needed, with consistently better adherence among those who used single-inhaler triple therapy (SITT).

These posters underscore the importance of early identification and treatment of chronic obstructive pulmonary disease (COPD), with better adherence and outcomes among those using single-inhaler triple therapy (SITT). | Image Credit: Orawan - stock.adobe.com

Real-World Utilization of Initial Pharmacological Treatments for COPD

Although the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends IPTs based on patients' status, data on real-world IPT utilization are limited.¹

Consequently, the first poster evaluated US patients with COPD and a history of exacerbations who initiated IPT with either dual therapy (long-acting β-agonist [LABA]/long-acting muscarinic antagonist [LAMA] or inhaled corticosteroid [ICS]/LABA) or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI]). The researchers evaluated their exacerbations and health care resource utilization (HCRU) during baseline and follow-up (12 months following/excluding the index date).

They analyzed patients from the US Optum Research Database with Medicare Advantage Part D or commercial insurance. Those eligible were at least 40 years old, began IPT between September 1, 2017, and March 31, 2022, and maintained continuous insurance enrollment for at least 12 months during the pre- and post-index periods. 

The study population consisted of 29,373 patients, 87.6% initiated dual therapy IPT and 12.4% initiated SITT. Of the dual therapy group, 25.7% used LABA/LAMA IPT, while 74.3% used ICS/LABA IPT.

During baseline vs follow-up, the mean (SD) number of exacerbations among SITT initiators was 1.5 (1.0) vs 0.8 (1.3), and the proportion of patients with 1 or more COPD-related inpatient stays was 20% vs 12.8%. Also, the mean (SD) length of stay (LoS) was 13.1 (30.5) days vs 16.4 (20.5) days during baseline vs follow-up, respectively.

As for LABA/LAMA initiators, the mean (SD) number of exacerbations at baseline vs follow-up was 1.4 (0.8) and 0.7 (1.1), respectively. Also, the number of patients with at least 1 COPD-related inpatient stay was 20.5% at baseline vs 10.7% during follow-up; the mean (SD) LoS was 12.2 (15.5) days at baseline vs 18.4 (22.9) days during follow-up.

Similarly, for ICS/LABA initiators, the mean (SD) number of exacerbations was 1.4 (0.8) at baseline vs 0.7 (1.1) during follow-up. However, the number of patients with at least 1 COPD-related inpatient stay was 23.6% at baseline vs 12.1% during follow-up, with the mean (SD) LoS being 13.3 (20.8) days vs 19.5 (27.0) days, respectively.

"We looked across the common maintenance therapies to see what happened with exacerbations and hospitalizations, and, of course, patients improved once they were treated, but it helped us see the unmet need of really identifying patients early, getting that assessment, and getting them an appropriate treatment," Presenter Kristi DiRocco, PharmD, respiratory medical director at GSK, told The American Journal of Managed Care^® (AJMC^®).

Treatment Adherence Among Patients With COPD

The second poster described the robustness of real-world data on patient adherence and persistence of SITT and MITT by consolidating the findings of recent international studies.²

Consequently, the researchers reviewed 4 real-world cohort studies: one from the US, United Kingdom (UK), Japan, and Germany, respectively. They measured medication adherence using the proportion of days covered (PDC) by MITT or SITT; a PDC of 80% or higher was considered adherent. Also, the researchers defined persistence as the proportion of patients meeting a minimum gap of 30 days between the end of 1 prescription and any following refill.

First, in the US study, eligible patients included those who initiated SITT and received FF/UMEC/VI or those who initiated MITT. It determined that patients who initiated SITT were more adherent (OR, 2.9; 95% CI, 2.5-3.3) and persistent (SITT, 35.7%; MITT, 13.9%) to treatment at 12 months post-index than patients who initiated MITT.

As for the UK study, the researchers included patients who initiated SITT if they received FF/UMEC/VI or beclomethasone dipropionate/glycopyrronium/formoterol fumarate (BDP/GLY/FOR). They found that patients who initiated SITT were more adherent (OR, 3.0; 95% CI, 2.7-3.4) and twice as likely to be persistent at 12 months post-index (SITT, 33.3%; MITT, 12.8%) than patients who initiated MITT.

Similarly, in the German study, eligible patients initiating SITT received FF/UMEC/VI or BDP/GLY/FOR. Like the other studies, patients who initiated SITT were considerably more adherent (OR, 5.9; 95% CI, 4.8-7.1) and persistent (SITT, 18.5%; MITT, 4.3%) with treatment at 12 months post-index than those receiving MITT.

Lastly, patients initiating SITT were included in the Japanese study if they received FF/UMEC/VI or budesonide/glycopyrronium/formoterol fumarate (BUD/GLY/FOR). As was discovered in the other 3 studies, patients who initiated SITT were more adherent (OR, 2.9; 95% CI, 1.5-5.4) and persistent at 12 months post-index than those receiving MITT.

The researchers noted that these data suggest a consistent benefit in adherence and persistence with SITT compared with MITT for patients with COPD, regardless of regional differences.

“These findings may help inform future real-world studies investigating triple and dual therapies as IPT and their role in improving patient outcomes and reducing the overall health care burden,” the authors concluded.

References

1. Anzueto AR, Paczkowski R, Dirocco K, Gronroos N, Veeranki P, Johnson M. Initial pharmacological treatment with dual or triple therapies among chronic obstructive pulmonary disease patients in the United States. Poster presented at: CHEST Annual Meeting 2024; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.2934
2. Paczkowski R, Sharma R, Sreedharan S, et al. Comparing patient adherence and persistence to single-inhaler triple therapy: a narrative review of real-world observational studies. Poster presented at: CHEST Annual Meeting 2024; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.2948