COPD: adherence, persistence with triple therapy with single or multiple inhalers

According to a recent study published in respiratory medicine. .

Although triple therapy – which consists of an inhaled corticosteroid, a long-acting muscarinic antagonist and a long-acting beta 2 agonist – is recommended for patients with COPD at risk of exacerbation, MITT is associated with poor compliance and poor persistence. The researchers therefore chose to assess the lesser known rates of adherence and persistence for single inhalers containing fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) by comparing rates among the 2 types of triple therapy for COPD.

The current study – a combined retrospective analysis of the United States and Canada of the IQVIA PharMetrics Plus claims database – involved 9,942 people, including 2,782 on single-inhaler FF/UMEC/VI and 7,160 on MITT. Eligible patients were 40 years of age or older and had 12 months or more of continuous insurance coverage before index treatment and 6 months or more of coverage after index treatment.

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The researchers used inverse probability weighting to balance baseline features. They assessed adherence using the proportion of days covered (PDC) and assessed relative risk using linear and log-binomial models. Persistence was calculated using Cox models; non-persistence was defined as an interval of more than 30 days between prescription refills.

Investigators found that compliance was higher for FF/UMEC/VI users compared to MITT users (mean PDC, 0.66 vs. 0.48; P <.001 single-inhaler triple therapy users were twice as likely to adhere treatment than mitt vs. relative risk ci>P <.001 single inhaler triple therapy users also had a significantly higher pdc than mitt at months against>P <.001>

In terms of persistence, FF/UMEC/VI users had a longer median duration of use (150 days) than MITT users (60 days). After 12 months, significantly more FF/UMEC/VI users continued to take their medication than MITT users (35.7% versus 13.9%, respectively; hazard ratio 1.91; 95% CI , 1.81-2.01; P <.001 during follow-up fewer patients in the single-inhaler triple therapy cohort required other copd medications short-acting beta-2 agonists antibiotics systemic corticosteroids and leukotriene modifiers than those mitt group.>

Strengths of this study include the use of real-world data, a geographically diverse sample, a short time between patient contact and data availability, and the propensity score-weighted cohort design of analysis. The study was limited by potentially inaccurate coding of COPD in the database; unavailability of information on race, socioeconomic status, education, and smoking history; no guarantee that the patient took the drug as prescribed; and drugs received during a hospital stay not being entered in the database.

The fact that adherence and persistence to triple therapy was higher with MITT than with single-inhaler triple therapy has important clinical implications, the researchers said. “Good adherence to treatment has been suggested to be key to a better prognosis in patients with COPD, with adherent patients having a lower risk of death and hospital admission due to exacerbation. “, noted the authors. “Persistence is an important indicator of long-term patient behavior and is essential for controlling symptoms, reducing the risk of exacerbation, improving quality of life, and increasing survival rates,” they explained.

Disclosure: Several authors have declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Mannino D, Bogart M, Wu B, et al. Adherence and persistence to once-daily single-inhaler triple therapy versus multiple-inhaler triple therapy in patients with chronic obstructive pulmonary disease in the United States: a real-world study. respiratory medicine. Published online March 18, 2022. doi:10.1016/j.rmed.2022.106807