Rates of escalation to triple COPD therapy among incident users of LAMA and LAMA/LABA. (June 2018)

• Record Type: Journal Article
• Authors: Hahn, Beth; Hull, Michael; Blauer-Peterson, Cori; Buikema, Ami R.; Ray, Riju; Stanford, Richard H.
• Is Part Of: Respiratory medicine. Volume 139(2018)
• Page Start: 65
• Page End: 71
• Publication Date: 2018-06
• Subjects: Combination therapy -- COPD -- Inhaled corticosteroids -- Long-acting bronchodilators -- LAMA/LABA -- Fixed-dose dual bronchodilators; CDS Chronic Disease Score -- CI confidence interval -- COPD chronic obstructive pulmonary disease -- ER emergency room -- FDC fixed-dose combination -- HR hazard ratio -- ICD-9-CM International Classification of Disease -- Ninth Revision Clinical Modification -- ICS inhaled corticosteroid -- IRR incidence rate ratio -- LABA long-acting β2-agonist -- LAMA long-acting muscarinic antagonist -- MAPD Medicare Advantage Part D -- OLO olodaterol -- PDE-4 phosphodiesterase-4 -- PDP Prescription Drug Plan -- PSM propensity score matching -- SABA short-acting β2-agonist -- SD standard deviation -- TIO tiotropium -- TT triple therapy -- UMEC umeclidinium -- VI vilanterol; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2018.04.014
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Improved outcomes have been reported for patients with chronic obstructive pulmonary disease (COPD) receiving combination long-acting muscarinic antagonist/long-acting β2 -agonist (LAMA/LABA) therapy compared with LAMA monotherapy. However, little is known about the relative characteristics of these patients and their rates of escalation to triple therapy (TT, combining a LAMA, LABA, and inhaled corticosteroid). This study aimed to characterize patients initiating treatment with the LAMA tiotropium (TIO) and the fixed-dose LAMA/LABA combination therapy umeclidinium/vilanterol (UMEC/VI), and to compare rates of escalation to TT between patients receiving these therapies. Methods: Retrospective study of patients with COPD enrolled in a US health insurance plan during 2013–2015 and newly initiated on TIO or UMEC/VI. Patients were ≥40 years of age at index (date of therapy initiation) with continuous enrollment for 12 months pre-index and ≥30 days post-index. LAMA users were propensity score matched 1:1 to LAMA/LABA users, with TT initiation rates reported by cohort using pharmacy claims. Results: 35, 357 patients initiating on TIO and 2407 patients initiating on UMEC/VI were identified. After propensity score matching, the rate of TT initiation was significantly higher in new TIO users (n = 1320) than in new UMEC/VI users (n = 1320) (0.92 vs 0.49 per 100 months of exposure, respectively; p < 0.001). Relative to the UMEC/VI cohort, the TIO cohort had an 87% higher risk of TT initiation (hazard ratio: 1.87; 95% confidence interval: 1.4–2.5; p = 0.001). Conclusions: Patients receiving UMEC/VI progressed to TT more slowly, and were at lower risk of progressing to TT, than patients receiving TIO. Highlights: UMEC/VI therapy was associated with slower progression to triple therapy than TIO. The risk of triple therapy initiation was 87% higher in TIO users than UMEC/VI users. Results suggest better symptom control and slower disease progression with UMEC/VI.