Factors associated with early adherence to tiotropium in chronic obstructive pulmonary disease

Abstract

Tiotropium is an innovative intervention in chronic obstructive pulmonary disease (COPD). Early adherence to tiotropium remains inadequately explored, notably time from initiation to discontinuation (persistence). In patients with COPD, the factors associated with the risk of discontinuing the treatment with tiotropium within 12 months following initiation were identified (12-month persistence). Claim databases from the French Social Security were used. A random sample of patients (aged 50-80 years) who initiated tiotropium soon after launch was selected. Factors associated with the persistence were investigated (Log-rank test and multivariate Cox model). Of the 1147 newly treated patients (mean age 68 years, 33% women), 64% remained in the treatment of tiotropium for over a period of 12 months following initiation. More than 10% of the patients interrupted therapy after a single dispensing, most often those with mild COPD. Lower risks of discontinuing tiotropium within 12 months following initiation were observed when it was initiated by a private sector specialist (hazard ratio (HR) ¼ 0.65, 95% confidence interval (CI) ¼ (0.52-0.82)), by hospital-based physician (HR ¼ 0.58, 95% CI ¼ (0.42-0.78)), when 2 other respiratory drugs were associated (HR ¼ 0.74, 95% CI ¼ (0.58-0.95)) and in case of long-term disease status (HR ¼ 0.78, 95% CI ¼ (0.63-0.97)). Conversely, no clear effect appeared according to age or gender. In this population of patients with COPD, fewer early discontinuations of tiotropium were observed in patients having a severe condition.

Tiotropium as part of inhaled polytherapy: Adherence and associated health‐care utilization

“…This result was similar to those found in the USA and the Netherlands, where similar definition of adherence and exlusion criteria were implemented. Different levels of adherence to Tiotropium that were found in other studies may be attributed to the use of different measures of adherence and differences in baseline COPD diagnosis and disease severity of study population. Unexpectedly, our study demonstrated no significant difference between adherent and non‐adherent patient with regard to age, gender, disease severity and comorbidities that were found previously to be associated with adherence in COPD .…”

“…This result was similar to those found in the USA and the Netherlands, where similar definition of adherence 31,32 and exlusion criteria 32 were implemented. Different levels of adherence to Tiotropium that were found in other studies [28][29][30]33 may be attributed to the use of different measures of adherence and differences in baseline COPD diagnosis and disease .143 † Adherent patients were defined as those whose proportion day covered (PDC) of Tiotropium was ≥80%. ‡ LABA and/or ICS refers to inhaled corticosteroids therapy (R03BA) and/or other long-acting beta-agonists, including salmeterol (R03AC12), formoterol (R03AC13), indacaterol (R03AC18), salmeterol and fluticasone (R03AK06), and formoterol and budesonide (R03AK07).…”

“…There is a growing body of evidence that adherence to COPD medications in real‐world settings is suboptimal, and that non‐adherence is associated with poor symptoms control, respiratory‐related HCU and reduction in health‐related quality of life . Few studies analysed objective measures of adherence to Tiotropium in clinical practice (rather than in clinical trials) . The adherence to Tiotropium in these studies was 20–40%, with the exception of 67% in the most recent study .…”

“…26,27 Few studies analysed objective measures of adherence to Tiotropium in clinical practice (rather than in clinical trials). [28][29][30][31][32][33] The adherence to Tiotropium in these studies was 20-40%, with the exception of 67% in the most recent study. 28 Only two of these studies analysed outcomes associated with adherence to Tiotropium, 29,31 but both referred to Tiotropium as a monotherapy without incorporating the change in patients' adherence to their additional inhaled therapy, and only one study analysed the influence of adherence on all-cause HCU.…”

“…[28][29][30][31][32][33] The adherence to Tiotropium in these studies was 20-40%, with the exception of 67% in the most recent study. 28 Only two of these studies analysed outcomes associated with adherence to Tiotropium, 29,31 but both referred to Tiotropium as a monotherapy without incorporating the change in patients' adherence to their additional inhaled therapy, and only one study analysed the influence of adherence on all-cause HCU. 31 Hence, the aim of the present study was to analyse patterns of all-cause HCU among patients with COPD who began therapy of Tiotropium incorporating measures of their adherence to additional inhaled therapy, that is LABA and/or ICS.…”