Initiating single-inhaler triple therapy for COPD improved persistence, outcomes vs. multiple inhalers

Initiating single-inhaler triple therapy for COPD, compared with multiple-inhaler triple therapy, resulted in improved persistence, which led to reductions in mortality, exacerbations and health care resource use in patients with COPD.

“Single (or fixed-dose) combination inhalers offer advantages to COPD patients by simplifying complex inhaler regimens, and single inhaler delivery of dual or triple therapy in COPD improves adherence and persistence compared with delivery using multiple inhalers,” Bernardino Alcázar-Navarrete, MD, from the pulmonology unit at the Virgen de las Nieves University Hospital, Granada, and CIBERES at the Carlos III Health Institute, Madrid, and colleagues wrote in Chest. “However, there is little evidence regarding the effectiveness of single-inhaler triple therapy vs. multiple-inhaler triple therapy in terms of exacerbation prevention and patient persistence, as well as economic impact.”

Researchers conducted a real-world, observational, retrospective cohort study and evaluated electronic health records to identify 4,625 patients with COPD aged 40 years and older who initiated single-inhaler triple therapy (n = 1,011; mean age, 71.2 years; 73.4% men) or multiple-inhaler triple therapy (n = 3,614; mean age, 70.9 years; 74% men) from June 2018 to December 2019. Researchers assessed comparative data on persistence, COPD exacerbation rates and health care resource utilization and costs during 12 months of follow-up.

Sixty-two percent of patients had moderate airflow limitation and 26.5% of patients had severe airflow limitation.

At 12-month follow-up, compared with patients who initiated multiple-inhaler triple therapy, those who initiated single-inhaler triple therapy had higher persistence (HR = 1.37; 95% CI, 1.22-1.53; P < .001), reduced COPD exacerbations (HR = 0.68; 95% CI, 0.61-0.77; P = .001) and reduced risk for all-cause mortality (HR = 0.67; 95% CI, 0.63-0.71; P = .027).

In addition, initiation of single-inhaler triple therapy was associated with significantly reduced health care resource utilization, with a mean annual cost savings of 408 euros compared with multiple-inhaler triple therapy. The researchers reported persistence was associated with improved COPD exacerbation rates compared with nonpersistence and substantial adjusted mean annual cost savings for both single- and multiple-inhaler triple therapy initiation.