<p>Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study</p>

Abstract

Background and objective Retrospective claims data in patients with chronic obstructive pulmonary disease (COPD) initiating maintenance therapy with inhaled fixed-dose combinations of long-acting muscarinic antagonist/long-acting β 2 -agonist (LAMA/LABA) versus inhaled corticosteroid (ICS)/LABA have not been reported. Methods Retrospective observational study in a COPD-diagnosed population of commercial and Medicare Advantage with Part D (MAPD) enrollees aged ≥40 years from a US health insurer database. Patients initiated umeclidinium/vilanterol (UMEC/VI [62.5/25 µg]) or fluticasone propionate/salmeterol (FP/SAL [250/50 µg]) between April 1, 2014 and August 31, 2016 (index date) and had 12 months continuous enrollment pre- and post-index. Exclusion criteria included an asthma diagnosis in the pre-index period/index date; ICS-, LABA-, or LAMA-containing therapy during the pre-index period; or pharmacy fills for both UMEC/VI and FP/SAL, multiple-inhaler triple therapy, a non-index therapy, or COPD exacerbation on the index date. Adherence (proportion of days covered [PDC] ≥80%) was modeled using weighted logistic regression following inverse probability of treatment weighting (IPTW). Weighted Kaplan–Meier and Cox proportional hazards regression following IPTW were performed for incidence of COPD exacerbation and escalation to multiple-inhaler triple therapy. Results The study population included 5306 patients (1386 initiating UMEC/VI and 3920 initiating FP/SAL). Adjusted odds of adherence were 2.00 times greater among UMEC/VI than FP/SAL initiators (95% confidence interval [CI]: 1.62─2.46; P <0.001). The adjusted hazard ratio (HR) for first exacerbation was 0.87 (95% CI: 0.74–1.01; P =0.067) among UMEC/VI versus FP/SAL initiators. UMEC/VI initiators had 35% lower adjusted risk of escalation to multiple-inhaler triple therapy (HR 0.65; 95% CI: 0.47–0.89; P =0.008) versus FP/SAL. On-treatment, UMEC/VI initiators had an adjusted 30% reduced risk of a first moderate/severe COPD exacerbation (HR 0.70; 95% CI: 0.54–0.90; P =0.006). Conclusion Patients with COPD initiating UMEC/VI had higher adherence and longer time before escalation to multiple-inhaler triple therapy than FP/SAL initiators.

Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities

“…In this study, the mean on-treatment time was longer in the UMEC/VI cohort compared with the FP/SAL, B/F, and TIO cohorts. Improvements in adherence with UMEC/VI versus FP/SAL, B/F, and TIO, which have been demonstrated in previous studies, 27,31 may have contributed to this difference and to the reduced medical costs and exacerbation risk observed in the current study.…”

“…This is consistent with the results of a previous claims-based study, which also demonstrated a reduced risk of moderate/severe exacerbation with UMEC/VI versus FP/SAL. 27 Interestingly, the rate of on-treatment COPD-related severe exacerbations among patients receiving UMEC/VI was significantly lower compared with those receiving FP/SAL and B/F, while the difference compared with TIO did not reach statistical significance. There is evidence to suggest that LAMA-containing maintenance treatments are more effective at reducing exacerbations than other maintenance medication classes; a network meta-analysis of 21 studies found that LAMA and LABA/LAMA therapies were ranked higher than ICS/LABA and LABA for reducing moderate/severe exacerbations in patients with COPD.…”

Real-World Treatment Patterns of Multiple-Inhaler Triple Therapy Among Patients with Chronic Obstructive Pulmonary Disease in UK General Practice

“… 18 In a US Medicare study, the incidence rate for MITT initiation was 0.018 and 0.027 per 100 patient-days in patients initiating LAMA/LABA and ICS/LABA, respectively; the LAMA/LABA initiators had a 35% lower risk of progression to MITT over 12 months following initiation. 19 A UK study recently illustrated that patients with COPD who were receiving LABA were more likely to add an additional maintenance therapy than those receiving a LAMA, and while patients who were treated with a LAMA primarily initiated MITT by adding an ICS/LABA, LABA monotherapy users typically received dual therapy prior to initiating MITT. 20 In the current study, most patients were receiving either an ICS/LABA (52%) or LAMA (31%) in the year prior to MITT initiation.…”

<p>Association Between Adherence to Maintenance Medication in Patients with COPD and Acute Exacerbation Occurrence and Cost in China: A Retrospective Cohort Database Study</p>

“…23 Another realworld study from the USA showed that patients starting a LAMA/LABA combination had higher adherence than patients starting an ICS/LABA combination. 24 Two studies from the United Kingdom revealed that the rate of prescribing according to the guidelines was low and that many patients were over-treated, and with poor adherence to treatment. 25,26 Therefore, the poor adherence and guideline compliance observed in China is probably not different from that observed in other countries.…”