Addition of a long-acting muscarinic antagonist (LAMA) is recommended for patients with asthma uncontrolled on inhaled corticosteroid/long-acting β-agonist (ICS/LABA) therapy. This is the first large-scale, real-world study examining multiple-inhaler triple-therapy (MITT) use in asthma.
To describe real-world prevalence, outcomes and treatment patterns associated with MITT.
This retrospective cohort study used medical and pharmacy claims from the Optum Research Database. Patients were diagnosed with asthma between January 01, 2013-July 31, 2018 with evidence of MITT use (≥1 overlapping days’ supply of ICS, LABA and LAMA). Annual MITT prevalence (primary endpoint) was assessed in the prevalent population; eligible patients were ≥18 years with ≥2 asthma diagnoses during the study period, and continuous enrollment for the entire year. Secondary outcomes (adherence [proportion of days covered [PDC]], MITT persistence, healthcare resource utilization [HCRU], costs) were assessed in the incident MITT population; eligible patients were ≥18 years, with ≥2 asthma diagnoses and continuous enrollment during both the 12-month baseline and 12-month follow-up periods. Patients with chronic obstructive pulmonary disease or cystic fibrosis were excluded.
MITT prevalence was low but increased from 0.35% (95% confidence interval [CI]: 0.32, 0.37) in 2014/2015 to 1.00% (95% CI: 0.96, 1.04) in 2017/2018. Among 1,831 incident MITT users there was a substantial disease burden, demonstrated by high HCRU and exacerbation rates. Adherence and persistence to MITT was low (mean [SD] PDC: 0.31 [0.27]) and 12% (n=216) remained on MITT 12 months post-initiation.
Overall, MITT use among patients with asthma is low. Patients initiating MITT have substantial disease burden and significant unmet needs.

Copyright © 2021. Published by Elsevier Inc.