Evaluation of Adherence and Persistence to Triple Therapy in Patients with COPD: A German Claims Data Study

IF 2.8 3区医学 Q1 Medicine

International Journal of Chronic Obstructive Pulmonary Disease Pub Date : 2024-08-09 DOI:10.2147/copd.s460903

Claus F Vogelmeier, Kai-Michael Beeh, Michael Schultze, Nils Kossack, Lena M Richter, Jing Claussen, Chris Compton, Stephen G Noorduyn, Afisi S Ismaila, Gema Requena

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引用次数: 0

Abstract

Purpose: Triple therapy (long-acting muscarinic antagonist/long-acting β₂-agonist/inhaled corticosteroid) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience recurrent exacerbations. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence. This study assessed comparative adherence and persistence to single-inhaler triple therapy (SITT) versus MITT among patients with COPD in a real-world setting in Germany.
Patients and Methods: This retrospective analysis using the WIG2 benchmark database identified patients with COPD newly initiating triple therapy with MITT or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or formoterol/beclomethasone/glycopyrronium bromide [FOR/BDP/GLY]) November 2017–June 2019. Eligible patients were ≥ 35 years with 1 year’s continual insurance prior to triple therapy initiation and no previous record of triple therapy. Inverse probability of treatment weighting was used to balance baseline characteristics. Adherence was measured using proportion of days covered (PDC) at 6, 12, and 18 months post-treatment initiation; persistence (time until treatment discontinuation) was measured at 6, 12, and 18 months, with a gap of > 30 days used to define non-persistence.
Results: Of 5710 patients included in the analysis (mean age 66 years), 71.4% initiated MITT and 28.6% initiated SITT (FF/UMEC/VI: 41.4%; FOR/BDP/GLY: 58.6%). Mean PDC was higher among SITT versus MITT users at all time points; at each time point, mean PDC was highest among FF/UMEC/VI users. During the first 6 months following treatment initiation, higher adherence was exhibited by FF/UMEC/VI (29%) and FOR/BDP/GLY (19%) users versus MITT users. Over the entire observation period, FF/UMEC/VI users had the highest proportion of persistent patients; at 18 months, 16.5% of FF/UMEC/VI users were persistent versus 2.3% of MITT users.
Conclusion: Patients initiating SITT in Germany had significantly higher adherence and persistence compared with patients initiating MITT over 6 to 18 months following treatment initiation. Among SITT, FF/UMEC/VI users had the highest proportion of adherence and persistence.

Keywords: comparative, multiple- or single-inhaler triple therapy, new-user, proportion of days covered, real-world analysis, treatment discontinuation

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评估慢性阻塞性肺病患者对三联疗法的依从性和持久性：一项德国索赔数据研究

目的：三联疗法（长效毒蕈碱类拮抗剂/长效β2-受体激动剂/口服皮质类固醇）被推荐用于反复发作的慢性阻塞性肺病（COPD）患者。多吸入器三联疗法（MITT）的依从性和持续性较差。本研究评估了德国实际环境中慢性阻塞性肺病（COPD）患者对单吸入器三联疗法（SITT）与多吸入器三联疗法的依从性和持续性的比较：这项回顾性分析使用 WIG2 基准数据库确定了 2017 年 11 月至 2019 年 6 月新开始使用 MITT 或 SITT（糠酸氟替卡松/优甲乐/维兰特罗 [FF/UMEC/VI] 或福莫特罗/倍氯米松/溴化甘草酸铵 [FOR/BDP/GLY]）三联疗法的 COPD 患者。符合条件的患者年龄≥35岁，在开始接受三联疗法前连续投保1年，且既往无三联疗法记录。采用治疗反概率加权法平衡基线特征。在开始治疗后的 6、12 和 18 个月，用覆盖天数比例（PDC）来衡量依从性；在 6、12 和 18 个月，衡量持续性（直至停止治疗的时间），用 30 天的间隙来定义非持续性：在纳入分析的 5710 名患者（平均年龄 66 岁）中，71.4% 开始接受 MITT 治疗，28.6% 开始接受 SITT 治疗（FF/UMEC/VI：41.4%；FOR/BDP/GLY：58.6%）。在所有时间点，SITT 用户的平均 PDC 均高于 MITT 用户；在每个时间点，FF/UMEC/VI 用户的平均 PDC 均最高。在开始治疗后的前 6 个月，FF/UMEC/VI（29%）和 FOR/BDP/GLY（19%）使用者的依从性高于 MITT 使用者。在整个观察期内，FF/UMEC/VI 使用者中坚持治疗的患者比例最高；18 个月时，16.5% 的 FF/UMEC/VI 使用者坚持治疗，而 MITT 使用者的坚持率为 2.3%：结论：在德国，开始接受 SITT 治疗的患者与开始接受 MITT 治疗的患者相比，在开始治疗后的 6 至 18 个月内，依从性和持续性明显更高。在SITT中，FF/UMEC/VI使用者的依从性和持续性比例最高。关键词：比较、多种或单一吸入器三联疗法、新使用者、覆盖天数比例、真实世界分析、治疗中断

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来源期刊

International Journal of Chronic Obstructive Pulmonary Disease RESPIRATORY SYSTEM-

CiteScore

5.10

自引率

10.70%

发文量

372

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals