Single vs Multiple Inhaler Triple Therapy for COPD Could Triple Adherence, Persistence: International Data

In adults with chronic obstructive pulmonary disease (COPD) across 4 continents, adherence to and persistence with triple inhaled therapy was “consistently better” among those using single inhaler triple therapy (SITT) compared with those using multiple-inhaler triple therapy (MITT).

The findings are from a narrative review of recent real-world studies presented at the CHEST 2024 Annual Meeting, October 6-9, 2024, in Boston, MA.

Investigators reviewed data from real-world cohort studies conducted in the US, United Kingdom (UK), Germany, and Japan. For each study they assessed medication adherence using the proportion of days covered (PDC) by MITT or SITT; a PDC of 80% or higher was considered adherent. Persistence for purposes of the study was defined as the proportion of patients that met a minimum gap of 30 days between the end of 1 prescription and any following refill.

Individuals eligible for the US study had initiated SITT with fluticasone furoate/ umeclidinium/vilanterol (FF/UMEC/VI) or had initiated MITT. Investigators reported that at 12 months after initiation, those who began 3-drug treatment with SITT were nearly 3 times more adherent (OR 2.9m, 95% CI 2.5-3.3) than those who initiated with MITT and were also more persistent with therapy (SITT 35.7%, MITT 13.9%).

The UK study included individuals who initiated SITT with FF/UMEC/VI or with beclomethasone dipropionate/glycopyrronium/formoterol fumarate (BDP/GLY/FOR) or MITT. As in the US study, adherence was 3-fold higher among participants who initiated SITT compared with MITT (OR 3.0, 95% CI 2.7-3.4) and the SITT initiators were more than twice as likely to be persistent at 12 months post-index compared with MITT starters (33.3% vs 12.8%, respectively).

Eligible participants in the German study had initiated SITT with FF/UMEC/VI or BDP/GLY/FOR. The odds of treatment adherence at 12 months post-index date with SITT vs MITT in this study were nearly double that of the US and UK studies (OR 5.9, 95% CI 4.8-7.1). Persistence at 12 months for SITT (18.5%) was more than 4 times more likely than for MITT (4.3%).

Finally, in the Japanese study eligible participants initiated SIIT with FF/UMEC/VI or budesonide/glycopyrronium/formoterol fumarate. Consistent with the other 3 studies, participants who began COPD treatment with SITT were close to 3 times more adherent (OR 2.9, 95% CI 1.5-5.4) and were also more persistent at 12 months post-index date than those receiving MITT.

The investigators acknowledge the “large amount of heterogeneity” among the studies, given differences in reimbursement timelines, practice patterns, and completeness of available data but maintain that “despite regional and methodological differences,” better adherence and persistence with SITT compared with MITT was consistent across the investigations. The investigators acknowledge the “large amount of heterogeneity” among the studies, given differences in reimbursement timelines, practice patterns, and completeness of available data but maintain that “despite regional and methodological differences,” better adherence and persistence with SITT compared with MITT was consistent across the investigations. The similarity across regions may inform future studies on the role of SITT in improving patient outcomes and reducing health care burden, authors concluded.

Source: Paczkowski R, Sharma R, Sreedharan S, et al. Comparing patient adherence and persistence to single-inhaler triple therapy: a narrative review of real-world observational studies. Poster presented at: CHEST 2024 Annual Meeting; October 6-9, 2024; Boston, MA. doi:10.1016/j.chest.2024.06.2948