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

Mannino, David M.; Bogart, Michael; Wu, Benjamin; Germain, Guillaume; Laliberté, François; MacKnight, Sean D.; Jung, Young Yun; Stiegler, Marjorie; Duh, Mei Sheng

doi:10.1016/j.rmed.2022.106807

Cited by 19 publications

(24 citation statements)

References 21 publications

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“…Multiple inhaler use is associated with low patient adherence and persistence to therapy in a real-world setting [ 41 , 42 ]. Patients receiving once-daily SITT with FF/UMEC/VI have been shown to have significantly higher adherence compared with patients receiving MITT [ 43 ], which may help to explain the observed differences in clinical outcomes. Consistent with this, SITT with FF/UMEC/VI was demonstrated to lead to greater improvements in quality of life (assessed using COPD Assessment Test [CAT] scores) and greater improvements in lung function compared with MITT in a real-world setting [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis

Ismaila

Haeussler²,

Czira

et al. 2022

Adv Ther

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Introduction: Randomized controlled trials (RCTs) comparing triple therapies (inhaled corticosteroid [ICS], long-acting b 2 -agonist [LABA], and long-acting muscarinic antagonist [LAMA]) for the treatment of chronic obstructive pulmonary disease (COPD) are limited. This network meta-analysis (NMA) investigated the comparative efficacy of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/ UMEC/VI) versus any triple (ICS/LABA/LAMA) combinations and dual therapies in patients with COPD. Methods: This NMA was conducted on the basis of a systematic literature review (SLR), which identified RCTs in adults aged at least 40 years with COPD. The RCTs compared different ICS/LABA/LAMA combinations or an

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Section: Discussionmentioning

confidence: 99%

Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis

Ismaila

Haeussler²,

Czira

et al. 2022

Adv Ther

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“…Finally, adherence and persistence were measured over a longer period in the current study compared with previous studies. 27 …”

Section: Discussionmentioning

confidence: 99%

“…Finally, adherence and persistence were measured over a longer period in the current study compared with previous studies. 27 Limitations of the current analysis include those common to database studies, eg inaccurate coding of COPD in the database and missing data. However, this is reflective of varying clinical documentation seen in real-world practice, 28 and COPD diagnoses and COPD exacerbations were defined based on a previous study, which validated…”

mentioning

confidence: 99%

Comparative Adherence and Persistence of Single- and Multiple-Inhaler Triple Therapies Among Patients with Chronic Obstructive Pulmonary Disease in an English Real-World Primary Care Setting

Halpin¹,

Rothnie²,

Banks³

et al. 2022

COPD

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Purpose Triple therapy comprising a long-acting muscarinic antagonist, long-acting β 2 -agonist and inhaled corticosteroid is recommended for patients with chronic obstructive pulmonary disease (COPD) who continue to experience frequent exacerbations or symptoms whilst receiving dual therapy. Adherence and persistence to multiple-inhaler triple therapy (MITT) is known to be poor. This study assessed comparative adherence to single-inhaler triple therapy (SITT) versus MITT in a real-world setting in England. Patients and Methods This was a retrospective cohort study using linked primary care (Clinical Practice Research Datalink Aurum) and secondary care (Hospital Episode Statistics [HES] Admitted Patient Care) data to identify patients with COPD who were newly initiated on SITT or MITT between November 2017 and June 2019. Eligible patients were aged ≥35 years and had a forced expiratory volume in 1 second/forced vital capacity <0.7, linkage to HES and continuous registration with a general practitioner for 12 months pre- and 6 months post-initiation. Inverse probability of treatment weighting was used to balance baseline characteristics between cohorts. Adherence was measured using the proportion of days covered by days’ supply of SITT or MITT prescriptions. Persistence was measured with a gap of >30 days between the end of a prescription and the following refill used to determine non-persistence. Results Overall, 4080 SITT and 6579 MITT users comprised the study cohort. After weighting, the baseline characteristics between the cohorts were comparable (absolute standardized mean difference <10%). SITT users had significantly higher adherence than MITT users at 6, 12, and 18 months post-initiation (p<0.001 for all comparisons). Median persistence was higher among SITT users than MITT users (5.09 months vs 0.99 months). Conclusion Patients with COPD in England initiating SITT had significantly better adherence and persistence compared with MITT initiators. These improvements continued at least 18 months following treatment initiation.

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“…In this context, another aspect that deserves further study is represented by the evaluation of the additional economic benefit that may derive from an improved patients' adherence to the treatment, that can now be delivered via a single device [19]. The therapeutic options currently include a single daily administration of fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/ VI) delivered through the multi-dose dry powder Ellipta device [20] or a twice-daily dose of budesonide, glycopyrrolate and formoterol administered via a pressurised metered dose inhaler (pMDI) [20,21]. Obviously, the choice of the device must take into account the preferences and characteristics of the patient [22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Economic impact of implementing prescription of single-inhaler triple therapies versus current multiple-inhaler triple therapies for COPD in the Apulia Region

Resta

Scioscia

Lacedonia

et al. 2022

BMC Health Serv Res

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Background The most impacting direct costs associated to COPD for the National Health Systems (NHS) are those related to accesses to the emergency room and hospital admissions, due to the onset of one or more COPD exacerbations. At the same time, severe COPD treatment, that often require a combination of medicaments, represents a substantial economic burden for the National Health Systems (NHS). This study aimed to evaluate the potential saving deriving from the implementation in the prescription of the two currently available single-inhaler triple therapies (SITTs) versus the currently used multiple-inhaler triple therapies (MITTs) in an eligible COPD population residing in the Apulia Region. Methods A budget impact model was developed hypothesizing the progressive replacement of the different MITTs on the reference market (Scenario A) with the pre-established SITTs, assuming a degree of penetration of 30%, 50% and 100% (Scenario B). Drug costs were based on prices published on the Official Gazette and therapy durations were based on prescribing information over the year 2019 (IQVIA™ prescription dataset). Results Our analysis showed that the extemporaneous MITT with the highest prevalence on the reference market was the inhaled corticosteroids/long-acting β2-agonists (ICS/LABA) combination plus a long-acting muscarinic antagonists (LAMA). This association of medicaments was paradoxically also the one associated to the highest expense value. The expanded use of a pre-established ICS/LAMA/LABA SITT was associated to a significant economic saving, ranging from a minimum of -€ 1,108,814 (SITT use: 30%) to a maximum of -€ 3,658,950 (SITT use: 100%). The cheapest pre-established SITT contained the fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) combination. Conclusion A pre-fixed ICS/LAMA/LABA SITT is cost-saving, compared to the different currently used extemporaneous MITTs. Clinicians should consider the potential benefits of finding less expensive regimens while maintaining adequate efficacy in the prescriptive decision making process of COPD patients.

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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

Cited by 19 publications

References 21 publications

Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis

Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis

Comparative Adherence and Persistence of Single- and Multiple-Inhaler Triple Therapies Among Patients with Chronic Obstructive Pulmonary Disease in an English Real-World Primary Care Setting

Economic impact of implementing prescription of single-inhaler triple therapies versus current multiple-inhaler triple therapies for COPD in the Apulia Region

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