Characteristics of New Users of Single- and Multiple-Inhaler Triple Therapy for COPD in Primary Care in England

Abstract

Purpose Inhaled triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who have poorly controlled symptoms and to reduce the risk of exacerbations. This study assessed the clinical characteristics of new users of single- and multiple-inhaler triple therapy (SITT and MITT) treated in a primary care setting in England. Patients and Methods This cross-sectional, observational study used data from an electronic health record database (CPRD Aurum) of COPD patients registered with a primary care practice in England, with linkage to a secondary care database. Patients were required to have initiated a new triple therapy (index) between November 2017 and November 2018 and have ≥12 months of available medical history prior to the index date. Results In total, 3536 patients initiated fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) SITT for the first time: 65% had a Medical Research Council (MRC) dyspnea score ≥3, 45% had forced expiratory volume in 1 second (FEV 1 )% predicted <50%, and 64% had a moderate or severe exacerbation in the previous 12 months. The majority (83%) of new FF/UMEC/VI users had a history of MITT use. Immediately prior to FF/UMEC/VI initiation, 46% received MITT, 25% received an inhaled corticosteroid (ICS)/long-acting β 2 -agonist (LABA), 12% received long-acting muscarinic antagonist (LAMA)/LABA, and 14% stepped up directly from LAMA monotherapy. A second cohort of 6540 patients initiated triple therapy (SITT or MITT) for the first time. COPD severity (airflow limitation, exacerbation history) was worse among patients initiating SITT versus MITT. In the 12 months before triple-therapy initiation, ICS/LABA was the most common treatment; a step up from LAMA/LABA was more common among patients initiating FF/UMEC/VI (34%) or beclomethasone/formoterol/glycopyrronium bromide SITT (25%) than MITT (14%). Conclusion First-time triple therapy was frequently initiated in patients with COPD inadequately controlled on maintenance therapy. General practitioners in England generally identify appropriate patients who require initiation of triple therapy.

Budesonide/Glycopyrrolate/Formoterol for the Management of COPD in a UK Primary Care Population: Real-World Use and Early Medication Success

“…A cross-sectional observational study of COPD patients attending primary care in England including 3536 new users of single-inhaler triple therapy reported similar levels of breathlessness, lung function impairment and treatment history among those prescribed triple therapy; 65% of patients had an MRC dyspnea score ≥3, 45% had predicted FEV 1 <50%, and 46%, 25% and 12% of patients had previously received multiple inhaler triple therapy, ICS/LABA or LABA/LAMA therapy, respectively, prior to triple therapy prescription. 31 Like our study, many patients appeared to have asthma in addition to…”

“… 31 Like our study, many patients appeared to have asthma in addition to COPD, which may have been the reason for initiation of an ICS-containing therapy (25% with current asthma compared to 30.9% in our study). 31 …”

“…COPD, which may have been the reason for initiation of an ICS-containing therapy (25% with current asthma compared to 30.9% in our study). 31 Our results highlighted some room for improvement in COPD diagnosis and optimization of treatment in the UK. We noted that only 33.7% had a spirometry confirmed COPD diagnosis.…”

Characteristics of Users and New Initiators of Single- and Multiple-Inhaler Triple Therapy for Chronic Obstructive Pulmonary Disease in Germany

“…7 Recent studies conducted in the UK, the US, and Japan have assessed characteristics of patients initiating MITT and SITT (Akiyama S, et al Characteristics of new users of single-and multiple-inhaler triple therapy for COPD in routine clinical practice in Japan: a cross-sectional, observational study [unpublished data]). [14][15][16] Data from the UK and the US suggest that MITT and SITT are frequently initiated following prior maintenance therapy, and in patients with a recent exacerbation, in line with current clinical guidance. [14][15][16] However, data from a similar retrospective cohort study conducted in Japan reported that 25% of patients initiating triple therapy had no prior history of ICS, LABA, or LAMA in the past 12 months (Akiyama S, et al Characteristics of new users of single-and multiple-inhaler triple therapy for COPD in routine clinical practice in Japan: a crosssectional, observational study [unpublished data]).…”

Outcomes of patients with COPD switching from multiple-inhaler to once-daily single-inhaler triple therapy in a real-world primary care setting in England: a retrospective pre-post cohort study

“…Switching from MITT to SITT is common in the UK. 18 Patients may switch for clinical reasons (eg, following an exacerbation), but also for economic reasons. Compared with MITT, SITT with FF/UMEC/VI has been shown to be a cost-effective treatment option for symptomatic patients with COPD who have a history of one or more exacerbations in a UK setting.…”