For chronic obstructive pulmonary disease (COPD) patients at risk of exacerbation, triple treatment with an inhaled corticosteroid, a long-acting muscarinic antagonist, and a long-acting β2 agonist (ICS/LAMA/LABA) is indicated. Multiple-inhaler triple treatment (MITT) was linked with poor adherence and persistence; however, similar results for single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) have not been studied.
For a study, researchers used the IQVIA PharMetrics Plus claims database to identify individuals with COPD who started triple treatment between September 18, 2017, and June 30, 2019. The index date was the first day of overlapping ICS, LAMA, and LABA prescriptions for MITT users or the first day of single-inhaler FF/UMEC/VI dispensing. Patients were ≥40 years old, and had at least ≥12 months of continuous insurance coverage before the index (baseline) and 6 months after the index; those who had MITT at baseline were omitted. To balance baseline attributes, inverse probability weighting was utilized. Adherence was measured using the proportion of days covered (PDC) and the linear and log-binomial models. Cox models were used to assess persistence (defined as a gap of more than 30 days between fillings).
The study comprised 9,942 patients (FF/UMEC/VI: 2,782; MITT: 7,160). Adherence was substantially greater for FF/UMEC/VI users compared to 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) as MITT users (46.5% vs. 22.3%; risk ratio [95% CI]: 2.08 [1.85–2.30]; P<0.001). After 12 months, FF/UMEC/VI users remained on therapy much longer than MITT users (35.7% vs. 13.9%; hazard ratio [95% CI]: 1.91 [1.81–2.01]; P<0.001). When compared to MITT, COPD patients who started on single-inhaler FF/UMEC/VI showed considerably better adherence and persistence.