Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study
Triple therapy comprising an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2 agonist (ICS/LAMA/LABA) is recommended for chronic obstructive pulmonary disease (COPD) patients at risk of exacerbation. Multiple-inhaler triple therapy (MITT) is associated with poor adherenc...
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| Veröffentlicht in: | Respiratory medicine 2022-06, Vol.197, p.106807-106807, Article 106807 |
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| creator | Mannino, David Bogart, Michael Wu, Benjamin Germain, Guillaume Laliberté, François MacKnight, Sean D. Jung, Young Stiegler, Marjorie Duh, Mei Sheng |
| description | Triple therapy comprising an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2 agonist (ICS/LAMA/LABA) is recommended for chronic obstructive pulmonary disease (COPD) patients at risk of exacerbation. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence; however, these outcomes have not been evaluated for single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).
This retrospective analysis of the IQVIA PharMetrics Plus claims database identified patients with COPD initiating triple therapy between 18 September 2017 and 30 June 2019. The first date of single-inhaler FF/UMEC/VI dispensing, or first day of overlapping ICS, LAMA, and LABA medications for MITT users, defined the index date. Patients were ≥40 years, had ≥12 months of continuous insurance coverage pre-index (baseline) and ≥6 months’ coverage post-index; those with MITT during baseline were excluded. Inverse probability weighting was used to balance baseline characteristics. Adherence was assessed using proportion of days covered (PDC) and was evaluated using linear and log-binomial models. Persistence (non-persistence identified as >30-day gap between fills) was evaluated using Cox models.
9942 patients (FF/UMEC/VI: 2782; MITT: 7160) were included. Adherence was significantly higher for FF/UMEC/VI versus MITT users (mean PDC, 0.66 vs. 0.48; p |
| doi_str_mv | 10.1016/j.rmed.2022.106807 |
| format | Article |
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This retrospective analysis of the IQVIA PharMetrics Plus claims database identified patients with COPD initiating triple therapy between 18 September 2017 and 30 June 2019. The first date of single-inhaler FF/UMEC/VI dispensing, or first day of overlapping ICS, LAMA, and LABA medications for MITT users, defined the index date. Patients were ≥40 years, had ≥12 months of continuous insurance coverage pre-index (baseline) and ≥6 months’ coverage post-index; those with MITT during baseline were excluded. Inverse probability weighting was used to balance baseline characteristics. Adherence was assessed using proportion of days covered (PDC) and was evaluated using linear and log-binomial models. Persistence (non-persistence identified as >30-day gap between fills) was evaluated using Cox models.
9942 patients (FF/UMEC/VI: 2782; MITT: 7160) were included. Adherence was significantly higher for FF/UMEC/VI versus MITT users (mean PDC, 0.66 vs. 0.48; p < 0.001), and FF/UMEC/VI users were twice as likely to be adherent (PDC ≥0.8) than MITT users (46.5% vs. 22.3%; risk ratio [95% CI]: 2.08 [1.85–2.30]; p < 0.001). After 12 months, significantly more FF/UMEC/VI users persisted on therapy than MITT users (35.7% vs. 13.9%; hazard ratio [95% CI]: 1.91 [1.81–2.01]; p < 0.001).
COPD patients initiating single-inhaler FF/UMEC/VI had significantly improved adherence and persistence compared with MITT.
•Adherence was higher for single-vs. multiple-inhaler triple therapy users with COPD.•After 12 months, more single-inhaler triple therapy users persisted on therapy.•Single-inhaler triple therapy users had lower use of other COPD treatments.•Single-inhaler triple therapy may help improve medication adherence and persistence.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1016/j.rmed.2022.106807</identifier><identifier>PMID: 35429764</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Administration, Inhalation ; Benzyl Alcohols - therapeutic use ; Bronchodilator Agents - therapeutic use ; Chlorobenzenes - therapeutic use ; Chronic obstructive pulmonary disease ; Drug Combinations ; Humans ; Medication adherence ; Multiple-inhaler triple therapy ; Muscarinic Antagonists - therapeutic use ; Nebulizers and Vaporizers ; Persistence ; Pulmonary Disease, Chronic Obstructive - drug therapy ; Quinuclidines - therapeutic use ; Retrospective Studies ; Single-inhaler triple therapy</subject><ispartof>Respiratory medicine, 2022-06, Vol.197, p.106807-106807, Article 106807</ispartof><rights>2022 The Authors</rights><rights>Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-2bfc230cfedf661971e7e344fc815b9a6ebbfa5ca6c323c93a526eb7a1c669f73</citedby><cites>FETCH-LOGICAL-c400t-2bfc230cfedf661971e7e344fc815b9a6ebbfa5ca6c323c93a526eb7a1c669f73</cites><orcidid>0000-0002-5369-1680 ; 0000-0001-5032-2110 ; 0000-0001-5035-6687 ; 0000-0002-9101-9641</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0954611122000725$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35429764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mannino, David</creatorcontrib><creatorcontrib>Bogart, Michael</creatorcontrib><creatorcontrib>Wu, Benjamin</creatorcontrib><creatorcontrib>Germain, Guillaume</creatorcontrib><creatorcontrib>Laliberté, François</creatorcontrib><creatorcontrib>MacKnight, Sean D.</creatorcontrib><creatorcontrib>Jung, Young</creatorcontrib><creatorcontrib>Stiegler, Marjorie</creatorcontrib><creatorcontrib>Duh, Mei Sheng</creatorcontrib><title>Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study</title><title>Respiratory medicine</title><addtitle>Respir Med</addtitle><description>Triple therapy comprising an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2 agonist (ICS/LAMA/LABA) is recommended for chronic obstructive pulmonary disease (COPD) patients at risk of exacerbation. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence; however, these outcomes have not been evaluated for single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).
This retrospective analysis of the IQVIA PharMetrics Plus claims database identified patients with COPD initiating triple therapy between 18 September 2017 and 30 June 2019. The first date of single-inhaler FF/UMEC/VI dispensing, or first day of overlapping ICS, LAMA, and LABA medications for MITT users, defined the index date. Patients were ≥40 years, had ≥12 months of continuous insurance coverage pre-index (baseline) and ≥6 months’ coverage post-index; those with MITT during baseline were excluded. Inverse probability weighting was used to balance baseline characteristics. Adherence was assessed using proportion of days covered (PDC) and was evaluated using linear and log-binomial models. Persistence (non-persistence identified as >30-day gap between fills) was evaluated using Cox models.
9942 patients (FF/UMEC/VI: 2782; MITT: 7160) were included. Adherence was significantly higher for FF/UMEC/VI versus MITT users (mean PDC, 0.66 vs. 0.48; p < 0.001), and FF/UMEC/VI users were twice as likely to be adherent (PDC ≥0.8) than MITT users (46.5% vs. 22.3%; risk ratio [95% CI]: 2.08 [1.85–2.30]; p < 0.001). After 12 months, significantly more FF/UMEC/VI users persisted on therapy than MITT users (35.7% vs. 13.9%; hazard ratio [95% CI]: 1.91 [1.81–2.01]; p < 0.001).
COPD patients initiating single-inhaler FF/UMEC/VI had significantly improved adherence and persistence compared with MITT.
•Adherence was higher for single-vs. multiple-inhaler triple therapy users with COPD.•After 12 months, more single-inhaler triple therapy users persisted on therapy.•Single-inhaler triple therapy users had lower use of other COPD treatments.•Single-inhaler triple therapy may help improve medication adherence and persistence.</description><subject>Administration, Inhalation</subject><subject>Benzyl Alcohols - therapeutic use</subject><subject>Bronchodilator Agents - therapeutic use</subject><subject>Chlorobenzenes - therapeutic use</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Drug Combinations</subject><subject>Humans</subject><subject>Medication adherence</subject><subject>Multiple-inhaler triple therapy</subject><subject>Muscarinic Antagonists - therapeutic use</subject><subject>Nebulizers and Vaporizers</subject><subject>Persistence</subject><subject>Pulmonary Disease, Chronic Obstructive - drug therapy</subject><subject>Quinuclidines - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Single-inhaler triple therapy</subject><issn>0954-6111</issn><issn>1532-3064</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFq3DAQhkVoSbZpX6CHomMv3kqyLK9KL0to00KghzZnIUvjrBbZciV5w75Yni9yNoGechpm5psfhg-hj5SsKaHiy34dB7BrRhgrA7Eh7Rla0aZmVU0Ef4NWRDa8EpTSC_QupT0hRHJOztFF3XAmW8FX6GFrdxBhNID1aPEEMbmUn_occCi1str5I05uvPNQuXGnPUR8KOCc8DD77Kb_5jkuLc4lVE9HrIcw3uFJZwdjTvje5R02uxhGZ3DoUo6zye4AeJp9IXU8YusS6ATYjUsIvv2z_Yq3OIL21X2I3uKUZ3t8j9722if48Fwv0e2P73-vflY3v69_XW1vKsMJyRXresNqYnqwvRBUthRaqDnvzYY2ndQCuq7XjdHC1Kw2stYNK7NWUyOE7Nv6En0-5U4x_JshZTW4ZMB7PUKYk2KioWIjJZcFZSfUxJBShF5N0Q3lJUWJWnypvVp8qcWXOvkqR5-e8-du2b2cvAgqwLcTAOXLg4OoknGLHusimKxscK_lPwJRMaw3</recordid><startdate>202206</startdate><enddate>202206</enddate><creator>Mannino, David</creator><creator>Bogart, Michael</creator><creator>Wu, Benjamin</creator><creator>Germain, Guillaume</creator><creator>Laliberté, François</creator><creator>MacKnight, Sean D.</creator><creator>Jung, Young</creator><creator>Stiegler, Marjorie</creator><creator>Duh, Mei Sheng</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5369-1680</orcidid><orcidid>https://orcid.org/0000-0001-5032-2110</orcidid><orcidid>https://orcid.org/0000-0001-5035-6687</orcidid><orcidid>https://orcid.org/0000-0002-9101-9641</orcidid></search><sort><creationdate>202206</creationdate><title>Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study</title><author>Mannino, David ; Bogart, Michael ; Wu, Benjamin ; Germain, Guillaume ; Laliberté, François ; MacKnight, Sean D. ; Jung, Young ; Stiegler, Marjorie ; Duh, Mei Sheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-2bfc230cfedf661971e7e344fc815b9a6ebbfa5ca6c323c93a526eb7a1c669f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Administration, Inhalation</topic><topic>Benzyl Alcohols - therapeutic use</topic><topic>Bronchodilator Agents - therapeutic use</topic><topic>Chlorobenzenes - therapeutic use</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Drug Combinations</topic><topic>Humans</topic><topic>Medication adherence</topic><topic>Multiple-inhaler triple therapy</topic><topic>Muscarinic Antagonists - therapeutic use</topic><topic>Nebulizers and Vaporizers</topic><topic>Persistence</topic><topic>Pulmonary Disease, Chronic Obstructive - drug therapy</topic><topic>Quinuclidines - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Single-inhaler triple therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mannino, David</creatorcontrib><creatorcontrib>Bogart, Michael</creatorcontrib><creatorcontrib>Wu, Benjamin</creatorcontrib><creatorcontrib>Germain, Guillaume</creatorcontrib><creatorcontrib>Laliberté, François</creatorcontrib><creatorcontrib>MacKnight, Sean D.</creatorcontrib><creatorcontrib>Jung, Young</creatorcontrib><creatorcontrib>Stiegler, Marjorie</creatorcontrib><creatorcontrib>Duh, Mei Sheng</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mannino, David</au><au>Bogart, Michael</au><au>Wu, Benjamin</au><au>Germain, Guillaume</au><au>Laliberté, François</au><au>MacKnight, Sean D.</au><au>Jung, Young</au><au>Stiegler, Marjorie</au><au>Duh, Mei Sheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study</atitle><jtitle>Respiratory medicine</jtitle><addtitle>Respir Med</addtitle><date>2022-06</date><risdate>2022</risdate><volume>197</volume><spage>106807</spage><epage>106807</epage><pages>106807-106807</pages><artnum>106807</artnum><issn>0954-6111</issn><eissn>1532-3064</eissn><abstract>Triple therapy comprising an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β2 agonist (ICS/LAMA/LABA) is recommended for chronic obstructive pulmonary disease (COPD) patients at risk of exacerbation. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence; however, these outcomes have not been evaluated for single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).
This retrospective analysis of the IQVIA PharMetrics Plus claims database identified patients with COPD initiating triple therapy between 18 September 2017 and 30 June 2019. The first date of single-inhaler FF/UMEC/VI dispensing, or first day of overlapping ICS, LAMA, and LABA medications for MITT users, defined the index date. Patients were ≥40 years, had ≥12 months of continuous insurance coverage pre-index (baseline) and ≥6 months’ coverage post-index; those with MITT during baseline were excluded. Inverse probability weighting was used to balance baseline characteristics. Adherence was assessed using proportion of days covered (PDC) and was evaluated using linear and log-binomial models. Persistence (non-persistence identified as >30-day gap between fills) was evaluated using Cox models.
9942 patients (FF/UMEC/VI: 2782; MITT: 7160) were included. Adherence was significantly higher for FF/UMEC/VI versus MITT users (mean PDC, 0.66 vs. 0.48; p < 0.001), and FF/UMEC/VI users were twice as likely to be adherent (PDC ≥0.8) than MITT users (46.5% vs. 22.3%; risk ratio [95% CI]: 2.08 [1.85–2.30]; p < 0.001). After 12 months, significantly more FF/UMEC/VI users persisted on therapy than MITT users (35.7% vs. 13.9%; hazard ratio [95% CI]: 1.91 [1.81–2.01]; p < 0.001).
COPD patients initiating single-inhaler FF/UMEC/VI had significantly improved adherence and persistence compared with MITT.
•Adherence was higher for single-vs. multiple-inhaler triple therapy users with COPD.•After 12 months, more single-inhaler triple therapy users persisted on therapy.•Single-inhaler triple therapy users had lower use of other COPD treatments.•Single-inhaler triple therapy may help improve medication adherence and persistence.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35429764</pmid><doi>10.1016/j.rmed.2022.106807</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-5369-1680</orcidid><orcidid>https://orcid.org/0000-0001-5032-2110</orcidid><orcidid>https://orcid.org/0000-0001-5035-6687</orcidid><orcidid>https://orcid.org/0000-0002-9101-9641</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Administration, Inhalation Benzyl Alcohols - therapeutic use Bronchodilator Agents - therapeutic use Chlorobenzenes - therapeutic use Chronic obstructive pulmonary disease Drug Combinations Humans Medication adherence Multiple-inhaler triple therapy Muscarinic Antagonists - therapeutic use Nebulizers and Vaporizers Persistence Pulmonary Disease, Chronic Obstructive - drug therapy Quinuclidines - therapeutic use Retrospective Studies Single-inhaler triple therapy |
| title | Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study |
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