Changes in Oral Corticosteroid Utilization in Patients with COPD Following Initiation of FF/UMEC/VI

Abstract

Michael Bogart,1 Carl B Abbott,2 Mohan Bangalore,3 Donna McMorrow,4 Elizabeth R Packnett,4 Kristi DiRocco3 1US Value Evidence and Outcomes, GSK, Durham, NC, USA; 2US Medical Affairs, GSK, Durham, NC, USA; 3US Medical Affairs, GSK, Collegeville, PA, USA; 4Merative, Ann Arbor, MI, USACorrespondence: Kristi DiRocco, US Medical Affairs, GSK, 1250 S. Collegeville Road, Collegeville, PA 19426, USA, Tel [phone], Email [email protected]: Oral corticosteroids (OCS) play a role in the treatment of acute chronic obstructive pulmonary disease (COPD) exacerbations; however, chronic use is not recommended due to the high rate of systemic complications, development of comorbidities, and increased mortality. Data assessing the real-world impact of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) on OCS utilization rates are limited. This study assessed the impact of FF/UMEC/VI on OCS use among patients with COPD previously treated with OCS.Patients and Methods: A retrospective database study of patients with COPD aged ≥ 40 years who initiated FF/UMEC/VI from 1 November 2017 to 31 December 2018, identified through the MarketScan® Commercial and Medicare Supplemental databases. Patients were required to have ≥ 1 dispensing of an OCS prior to initiation of FF/UMEC/VI (index) and were followed up for 12 months post-index. OCS utilization patterns, potential OCS-related adverse events, healthcare resource utilization (HCRU), and costs were compared between the 12-month pre- and post-index periods.Results: A total of 2013 patients were identified (mean age 63.5 years, 55.7% female). The proportion of patients with ≥ 1 OCS claim decreased by 32.2% between the pre- and post-index period (67.8% vs 100%; p < 0.001). Comparing the post-index period to the pre-index period, mean number of OCS pharmacy claims per patient decreased from 3.3 to 2.5 (p < 0.001) and mean daily dose was reduced from 3.1 to 2.6 mg/day (p = 0.004); 30.0% of patients reduced their daily dose by 90– 100%. Reductions were also seen in COPD-related HCRU. The proportion of patients with an inpatient admission for COPD decreased from 11.4% to 7.1% (p < 0.001), emergency room visits decreased from 23.1% to 17.4% (p < 0.001), and office visits from 97.5% to 90.1% (p < 0.001). Similar results were seen for all-cause HCRU.Conclusion: Among patients with COPD with prior OCS use, FF/UMEC/VI initiation resulted in significant reductions in OCS utilization, COPD-related HCRU (including hospitalization), and all-cause HCRU.Plain Language Summary: Oral corticosteroids (OCS) are drugs that are often used in the short term to treat chronic obstructive pulmonary disease (COPD) exacerbations. Long-term use of OCS is not recommended as this can increase the risk of pneumonia and death. Fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is a maintenance treatment for COPD, which combines three drugs into one inhaler. In this study, we investigated OCS use before and after starting FF/UMEC/VI. We found that there were 32.2% less patients with an OCS claim in the year after starting FF/UMEC/VI compared with the year before. In addition, 30.0% of patients reduced their daily OCS dose by 90– 100%. We also looked at how often patients were using healthcare services because of their COPD after starting FF/UMEC/VI, and how much this cost. We found that there were fewer inpatient stays, emergency room visits, and doctor’s office visits due to COPD in the year after starting FF/UMEC/VI treatment compared with the year before. Overall, these results show that patients who use OCS every day may be able to reduce their dose after starting FF/UMEC/VI treatment, which may avoid some of the potential side effects of OCS.Keywords: COPD, FF/UMEC/VI, oral corticosteroids

Keywords

• copd
• ff/umec/vi
• oral corticosteroids