Initiation of single-inhaler COPD triple therapy improved adherence vs. multiple inhalers

Patients with COPD who initiated of single-inhaler triple therapy had improved inhaler adherence and persistence compared with multiple-inhaler triple therapy users, according to a real-world study.

Researchers conducted a retrospective analysis of 2,782 patients with COPD (mean age, 60.6 years; 54.5% women) in the IQVIA PharMetrics Plus claims database who initiated triple therapy with fluticasone furoate, umeclidinium and vilanterol (Trelegy Ellipta; GlaxoSmithKline and Innoviva) from September 2017 to June 2019. Researchers also examined data from 7,160 patients using multiple-inhaler triple therapy (mean age, 60.4 years; 52.1% women). All patients were aged at least 40 years and had at least 12 months of continuous insurance coverage before initiation and at least 6 months of coverage after initiation.

At 6 months, patients who initiated single-inhaler triple therapy had higher inhaler adherence, with a mean proportion of days covered of 0.66 vs. 0.48 (P < .001).

Researchers also analyzed 1,337 single-inhaler triple therapy users and 3,442 multiple-inhaler triple therapy users with 12 or more months of follow-up data in a subgroup analysis. In the subgroup analysis, single-inhaler triple therapy users had higher proportion of days covered compared with multiple-inhaler triple therapy users (0.6 vs. 0.4; P < .001).

Compared with multiple-inhaler triple therapy, single-inhaler triple therapy users were also twice as likely to be adherent to their inhaler treatment (22.3% vs. 46.5%; RR = 2.08; 95% CI, 1.85-2.3; P < .001). The likelihood of adherence for single-inhaler triple therapy users rose to 62% when defining adherence as the proportion of days covered as 0.5 or more compared with multiple-inhaler triple therapy users (72.4% vs. 44.7%; RR = 1.62; 95% CI, 1.48-1.73; P < .001). In the subgroup analysis, single-inhaler triple therapy users also had higher adherence compared with multiple-inhaler triple therapy users based on proportion of days covered of 0.8 or more (43.2% vs. 17.4%; P < .001) and 0.5 or more (60.7% vs. 35.1%; P < .001).

In the subgroup analysis, after 12 months, more patients who initiated single-inhaler triple therapy persisted with their treatment compared with patients using multiple-inhaler triple therapy (35.7% vs. 13.9%; HR = 1.91; 95% CI, 1.81-2.01; P < .001).

“Thus, the improvements in adherence and persistence seen in this study for patients initiating single-inhaler fluticasone furoate/umeclidinium/vilanterol are very promising. Further studies are required to understand how the observed improvements in adherence and persistence with fluticasone furoate/umeclidinium/vilanterol translate into clinical and economic benefits,” David Mannino, MD, respiratory medical expert at GlaxoSmithKline, and colleagues wrote in Respiratory Medicine.