Medication adherence and persistence in chronic obstructive pulmonary disease patients receiving triple therapy in a USA commercially insured population

Abstract

Introduction

This longitudinal, retrospective cohort study of patients with COPD describes baseline characteristics, adherence, and persistence following initiation of inhaled corticosteroids (ICS)/long-acting β₂-agonists (LABA)/long-acting muscarinic antagonists (LAMA) from multiple inhaler triple therapy (MITT).

Methods

Patients aged ≥40 years receiving MITT between January 2012 and September 2015 were identified from the IQVIA™ Real-world Data Adjudicated Claims–USA database. MITT was defined as subjects with ≥1 overlapping days’ supply of three COPD medications (ICS, LABA, and LAMA). Adherence (proportion of days covered, PDC) and discontinuation (defined as a gap of 1, 30, 60, or 90 days of supply in any of the three components of the triple therapy) were calculated for each patient over 12 months of follow-up. In addition, analyses were stratified by number of inhalers.

Results

In total, 14,635 MITT users were identified (mean age, 62 years). Mean PDC for MITT at 12 months was 0.37%. Mean PDC for the ICS/LABA and LAMA component at 12 months was 49% (0.49±0.31; median, 0.47) and 54% (0.54±0.33; 0.56), respectively. The proportion of adherent patients (PDC ≥0.8) at 12 months was 14% for MITT. Allowing for a 30-day gap from last day of therapy, 86% of MITT users discontinued therapy during follow-up.

Conclusion

Patients with COPD had low adherence to and persistence with MITT in a real-world setting. Mean PDC for each single inhaler component was higher than the mean PDC observed with MITT. Reducing the number of inhalers may improve overall adherence to intended triple therapy.

Keywords:

• chronic obstructive pulmonary disease
• COPD
• medication adherence
• inhaled corticosteroids
• ICS
• long-acting β₂-agonists
• LABA
• long-acting muscarinic antagonists
• LAMA
• multiple inhaler triple therapy

Acknowledgments

A description of the study and some of the results described in this article have been reported previously in the form of an abstract for the American Thoracic Society 2018 International Conference.⁴⁸ This study was funded by GlaxoSmithKline plc. (Study HO-17-17694). Medical writing support in the form of development of the draft outline and manuscript first draft in consultation with the authors, editorial suggestions to draft versions of this paper, assembling tables and figures, collating author comments, copyediting, referencing, and graphic services was provided by Catherine Amey, BSc of Gardiner-Caldwell Communications, Macclesfield, UK and was funded by GlaxoSmithKline plc.

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

MB and RHS are employees of GlaxoSmithKline plc. and own shares in GSK. FL, GG, JWW, and MSD are employees of Analysis Group, Inc., a consulting company that has received research funds from GlaxoSmithKline plc. to conduct this study but they were not paid for manuscript development. The authors report no other conflicts of interest in this work.