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

Abstract

Kieran J Rothnie,1 Sandra Joksaite,1 Leah B Sansbury,2 Chris Compton,3 Valentina Di Boscio,4 Afisi S Ismaila5,6 1Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, London, UK; 2Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, Research Triangle Park, NC, USA; 3Global Medical Affairs, GlaxoSmithKline, Middlesex, UK; 4Global Medical Affairs, GlaxoSmithKline, Ealing, UK; 5Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, Collegeville, PA, USA; 6Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Kieran J Rothnie, Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, London, UK, Tel [phone], Email [email protected]: 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 (FEV1)% 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 β2-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.Keywords: chronic obstructive pulmonary disease, multiple-inhaler triple therapy, patient characteristics, single-inhaler triple therapy, triple therapy

Keywords

• chronic obstructive pulmonary disease
• multiple-inhaler triple therapy
• patient characteristics
• single-inhaler triple therapy
• triple therapy