Fluticasone Furoate/Umeclidinium/Vilanterol Initiation Following a COPD Exacerbation: Benefits of Prompt Initiation on COPD Outcomes

IF 3.4 3区医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL

Advances in Therapy Pub Date : 2024-10-25 DOI:10.1007/s12325-024-02999-3

David Mannino, Kristi DiRocco, Guillaume Germain, François Laliberté, Stephen G. Noorduyn, Ana Urosevic, Rosirene Paczkowski

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引用次数: 0

Abstract

Introduction

Previous real-world evidence suggests that prompt versus delayed initiation of single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following an exacerbation results in improved clinical outcomes for patients with chronic obstructive pulmonary disease (COPD). This prior study was conducted in the first 2 years following FF/UMEC/VI approval, representing early trends. The current updated analysis aims to further elucidate the real-world evidence for FF/UMEC/VI.

Methods

This was a retrospective cohort study using the IQVIA PharMetrics^® Plus database. Patients with COPD initiating SITT with FF/UMEC/VI within 6 months of an exacerbation (index date) were classified as prompt (≤ 30 days following exacerbation) or delayed (31–180 days) initiators. The baseline period comprised the 12 months prior to index. Inverse probability of treatment weighting was used to balance differences in baseline characteristics between cohorts. COPD exacerbations, hospital readmission rates, and healthcare costs were compared between cohorts post-index.

Results

Overall, 5421 patients (prompt, 2057; delayed, 3364) were included. After weighting, baseline characteristics were well balanced between cohorts. For up to 12 months post-index, prompt initiators of FF/UMEC/VI had significantly lower rates of exacerbations per person-year versus delayed initiators (0.74 vs. 1.06; rate ratio 0.70, 95% confidence interval [CI] 0.64–0.77; P < 0.001). A 1-day delay in FF/UMEC/VI initiation was associated with a 0.31% increase in the rate of exacerbations. At 90 days post-index, Kaplan–Meier rates of all-cause (hazard ratio [HR] 0.62, 95% CI 0.45–0.86; P = 0.004) and COPD-related (HR 0.58, 95% CI 0.35–0.98; P = 0.042) hospital readmissions were significantly lower in the prompt versus delayed cohort. Total COPD-related healthcare costs per person per year were significantly lower for patients in the prompt versus delayed cohort.

Conclusion

Healthcare providers should consider the positive impact of prompt FF/UMEC/VI initiation on exacerbation rate, hospital readmission rate, and costs when treating patients with COPD at risk of exacerbations.

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慢性阻塞性肺疾病加重后开始使用糠酸氟替卡松/优甲乐/维兰特罗：慢性阻塞性肺疾病加重后开始使用氟他松糠酸盐/优甲乐胺/维兰特罗：及时用药对慢性阻塞性肺疾病结果的益处。

简介：以往的真实世界证据表明，慢性阻塞性肺疾病（COPD）患者在病情加重后及时开始使用糠酸氟替卡松/优甲乐/维兰特罗（FF/UMEC/VI）单吸入器三联疗法（SITT）与延迟开始使用单吸器三联疗法（SITT）相比，临床疗效有所改善。之前的研究是在 FF/UMEC/VI 获批后的头两年进行的，代表了早期趋势。目前更新的分析旨在进一步阐明 FF/UMEC/VI 的实际证据：这是一项使用 IQVIA PharMetrics® Plus 数据库进行的回顾性队列研究。在病情加重（指数日期）后 6 个月内使用 FF/UMEC/VI 启动 SITT 的慢性阻塞性肺病患者被分为及时启动者（病情加重后≤ 30 天）和延迟启动者（31-180 天）。基线期包括指数前的 12 个月。采用治疗反概率加权法来平衡各组间基线特征的差异。比较了各组间指数后的慢性阻塞性肺疾病恶化情况、再入院率和医疗费用：共纳入 5421 名患者（及时治疗 2057 人；延迟治疗 3364 人）。加权后，各组间的基线特征非常均衡。在指数发布后长达 12 个月的时间里，及时启动 FF/UMEC/VI 的患者与延迟启动者相比，每人年的病情恶化率明显较低（0.74 vs. 1.06；比率比 0.70，95% 置信区间 [CI] 0.64-0.77; P 结论：医疗服务提供者应考虑到 FF/UMEC/VI 的积极影响：医疗服务提供者在治疗有病情加重风险的慢性阻塞性肺病患者时，应考虑及时启动 FF/UMEC/VI 对病情加重率、再入院率和费用的积极影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Therapy 医学-药学

CiteScore

7.20

自引率

2.60%

发文量

353

审稿时长

6-12 weeks

期刊介绍： Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.