Real-World Treatment Patterns of Multiple-Inhaler Triple Therapy Among Patients with Chronic Obstructive Pulmonary Disease in UK General Practice

• Main Authors: Sansbury LB, Bains C, Lipson DA, Ismaila AS, Landis SH
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-05-01
• Series: International Journal of COPD
• Subjects: chronic obstructive pulmonary disease (copd); multiple-inhaler triple therapy (mitt); general practice; real world; treatment patterns.
• Online Access: https://www.dovepress.com/real-world-treatment-patterns-of-multiple-inhaler-triple-therapy-among-peer-reviewed-fulltext-article-COPD

Leah B Sansbury,1 Chanchal Bains,2 David A Lipson,3,4 Afisi S Ismaila,5,6 Sarah H Landis5 1Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 2Value Evidence and Outcomes, GlaxoSmithKline, Uxbridge, UK; 3Clinical Sciences, GlaxoSmithKline, Collegeville, PA, USA; 4Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 5Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA; 6Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, CanadaCorrespondence: Leah B SansburyValue Evidence and Outcomes, GlaxoSmithKline, Building 5, 42 Moore Drive, Research Triangle Park, NC, 27709, USATel [phone]Email [e-mail]: Until recently, triple therapy for chronic obstructive pulmonary disease (COPD) has only been available through treatment with multiple inhalers. Evidence on real-world use of multiple-inhaler triple therapy (MITT), including duration of use and treatment patterns, is limited.Methods: A retrospective, observational study of electronic health records and hospital episodes in patients with COPD initiating MITT between 2013 and 2015 in the UK was performed. This study described patients initiating, treatment persistence and discontinuation, and prior and subsequent COPD treatments.Results: Eligible patients (N=3825) had a mean age of 69.5 years; most were former or current smokers (95%). The majority (86%) initiated MITT with two inhalers and 14% initiated with three inhalers. Mean duration of use was 5.1 (standard deviation: 4.6) months; 24% of patients persisted for 12 months. Patients who had significantly poorer lung function at baseline (12 months prior to initiating MITT) and had experienced significantly more moderate-to-severe acute exacerbation of COPD (AECOPD) and hospitalizations during the baseline period were more likely to persist for 12 months, compared with those who discontinued within 12 months. Most patients stepped down to an inhaled corticosteroid/long-acting β2-agonist combination (ICS/LABA; 48%) or a long-acting muscarinic antagonist (LAMA; 45%) after discontinuing MITT.Conclusion: Initiation of MITT occurred in patients with clinically relevant symptoms and a history of AECOPD. Persistence varied and was most likely linked to disease severity, although more research is required to fully understand why patients discontinue MITT, the subsequent clinical consequences of therapy discontinuation, and the potential impact of newly available single-inhaler triple therapies.Keywords: chronic obstructive pulmonary disease, COPD, multiple-inhaler triple therapy, MITT, general practice, real world, treatment patterns