Outcomes of patients with COPD switching from multiple-inhaler to once-daily single-inhaler triple therapy in a real-world primary care setting in England: a retrospective pre-post cohort study

• Published in: BMJ open respiratory research Vol. 11; no. 1; p. e001890
• Main Authors: Rothnie, Kieran J, Wood, Robert P, Czira, Alexandrosz, Banks, Victoria L, Camidge, Lucinda J, Massey, Olivia K I, Seif, Monica, Compton, Chris, Sharma, Raj, Halpin, David M G, Ismaila, Afisi S, Vogelmeier, Claus F
• Format: Journal Article
• Language: English
• Published: England British Thoracic Society 21.05.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Administration, Inhalation; Aged; Androstadienes; Benzyl Alcohols - administration & dosage; Bronchodilator Agents - administration & dosage; Chlorobenzenes - administration & dosage; Chronic Obstructive Pulmonary Disease; Codes; Cohort analysis; COPD Exacerbations; Cost estimates; Drug Combinations; Electronic health records; England; Female; Health care expenditures; Hospitals; Humans; Inhalers; Male; Middle Aged; Muscarinic Antagonists - administration & dosage; Nebulizers and Vaporizers; Patient admissions; Prescriptions; Primary care; Primary Health Care; Pulmonary Disease, Chronic Obstructive - drug therapy; Quinuclidines - administration & dosage; Retrospective Studies; Sensitivity analysis; Treatment Outcome; England; United Kingdom > UK; COPD Exacerbations
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2023-001890

BackgroundCompared with multiple-inhaler triple therapy (MITT), single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) demonstrated improved lung function and meaningful improvements in chronic obstructive pulmonary disease (COPD) Assessment Test score. This real-world study compared the effectiveness of switching patients with COPD in England from MITT to once-daily SITT with FF/UMEC/VI by evaluating rates of COPD exacerbation, healthcare resource use (HCRU) and associated direct medical costs.MethodsRetrospective cohort pre-post study using linked primary care electronic health record and secondary care administrative datasets. Patients diagnosed with COPD at age ≥35 years, with smoking history, linkage to secondary care data and continuous GP registration for 12 months pre-switch and 6 months post-switch to FF/UMEC/VI were included. Index date was the first initiation of an FF/UMEC/VI prescription immediately following MITT use from 15 November 2017 to 30 September 2019. Baseline was 12 months prior to index, with outcomes assessed 6/12 months pre-switch and post-switch, and stratified by prior COPD exacerbation status.ResultsWe included 2533 patients (mean [SD] age: 71.1 [9.9] years; 52.1% male). In the 6 months post-switch, there were significant decreases in the proportion of patients experiencing ≥1 moderate-to-severe (36.2%–28.9%), moderate only (24.4%–19.8%) and severe only (15.4%–11.8%) COPD exacerbation (each, p<0.0001) compared with the 6 months pre-switch. As demonstrated by rate ratios, there were significant reductions in exacerbation rates of each severity overall (p<0.01) and among patients with prior exacerbations (p<0.0001). In the same period, there were significant decreases in the rate of each COPD-related HCRU and total COPD-related costs (−24.9%; p<0.0001).ConclusionPatients with COPD switching from MITT to once-daily SITT with FF/UMEC/VI in a primary care setting had significantly fewer moderate and severe exacerbations, and lower COPD-related HCRU and costs, in the 6 months post-switch compared with the 6 months pre-switch.