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Baseline Characteristics and Treatment Patterns of New Users to Multiple Inhaler Triple Therapy
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A4999 - Baseline Characteristics and Treatment Patterns of New Users to Multiple Inhaler Triple Therapy
Author Block: R. H. Stanford1, M. S. Hull2, E. Hulbert2, A. R. Buikema2, T. K. Reinsch1, M. Bogart1; 1GlaxoSmithKline, Research Triangle Park, NC, United States, 2Optum, Eden Prairie, MN, United States.
Introduction: Multiple inhaler triple therapy (MITT) with an inhaled corticosteroid (ICS), long acting β2-agonist (LABA), and a long-acting anti-muscarinic agent (LAMA) can be used in COPD patients needing additional symptom control or continue to exacerbate despite current maintenance treatment. The purpose of this study was to characterize baseline characteristics and treatment use prior to the initiation of MITT.
Methods: This was a retrospective cross sectional study of patients enrolled in commercial and Medicare Part D health plans, identified between 1/1/2014 and 3/31/2016. Patients (age ≥40) had 15 months’ continuous enrollment pre-index and 90-days post-index. Patients with a diagnosis of COPD (ICD-9/10 codes) were identified as MITT users at index if they had ≥1 day of overlap of a LAMA, LABA, and ICS pharmacy dispensing (index date). Baseline characteristics, medication patterns, and exacerbation history were described in the 12 months prior to initiation of MITT; laboratory eosinophil levels were reported in a subset of patients with ≥1 eosinophil measurement in the prior 12 months.
Results: A total of 13,701 patients (age 69.3 ± 10.0 years, 53.3% female) met all study criteria. Hypertension (76.1%), heart disease (68.6%), and dyslipidemia (66.1%) were common; 39.7% of patients had concomitant asthma. On the index date, MITT was composed mostly of fixed dose ICS/LABA + LAMA (97.0%).
Overall, 82.6% of patients had ≥1 inhaled maintenance medication (ICS, LABA, or LAMA) fill in the 12 months prior to initiation of triple. The most common medication regimens filled were any ICS + LABA combination (32.9%) or a LAMA (23.0%), without fills for other inhaled COPD maintenance medication classes; 24.9% of patients filled one medication class, 37.3% filled two medication classes, and 17.4% filled none. During the 12-month baseline, 6.4% of patients had a severe exacerbation and 59.8% had a severe or moderate exacerbation; 90.4% of patients had fill for an ICS + LABA, LABA, or LAMA, or had an exacerbation prior to triple therapy.
The mean blood eosinophil count (n=3,109) during the baseline period was 336 ± 2422.8 cells/μL. Most patients (66.5%) had EOS ≥150 cells/μL and 20.2% of patients had high values, above 350 cells/μL.
Conclusions: This analysis shows that physicians are using MITT after use of other inhaled COPD maintenance therapies or in patients with risk for exacerbations, which is aligned with current COPD treatment strategies. Less than 10% of MITT use was in patients without prior treatment or exacerbation risk.
Funding: GSK, study HO-16-16350.
Author Block: R. H. Stanford1, M. S. Hull2, E. Hulbert2, A. R. Buikema2, T. K. Reinsch1, M. Bogart1; 1GlaxoSmithKline, Research Triangle Park, NC, United States, 2Optum, Eden Prairie, MN, United States.
Introduction: Multiple inhaler triple therapy (MITT) with an inhaled corticosteroid (ICS), long acting β2-agonist (LABA), and a long-acting anti-muscarinic agent (LAMA) can be used in COPD patients needing additional symptom control or continue to exacerbate despite current maintenance treatment. The purpose of this study was to characterize baseline characteristics and treatment use prior to the initiation of MITT.
Methods: This was a retrospective cross sectional study of patients enrolled in commercial and Medicare Part D health plans, identified between 1/1/2014 and 3/31/2016. Patients (age ≥40) had 15 months’ continuous enrollment pre-index and 90-days post-index. Patients with a diagnosis of COPD (ICD-9/10 codes) were identified as MITT users at index if they had ≥1 day of overlap of a LAMA, LABA, and ICS pharmacy dispensing (index date). Baseline characteristics, medication patterns, and exacerbation history were described in the 12 months prior to initiation of MITT; laboratory eosinophil levels were reported in a subset of patients with ≥1 eosinophil measurement in the prior 12 months.
Results: A total of 13,701 patients (age 69.3 ± 10.0 years, 53.3% female) met all study criteria. Hypertension (76.1%), heart disease (68.6%), and dyslipidemia (66.1%) were common; 39.7% of patients had concomitant asthma. On the index date, MITT was composed mostly of fixed dose ICS/LABA + LAMA (97.0%).
Overall, 82.6% of patients had ≥1 inhaled maintenance medication (ICS, LABA, or LAMA) fill in the 12 months prior to initiation of triple. The most common medication regimens filled were any ICS + LABA combination (32.9%) or a LAMA (23.0%), without fills for other inhaled COPD maintenance medication classes; 24.9% of patients filled one medication class, 37.3% filled two medication classes, and 17.4% filled none. During the 12-month baseline, 6.4% of patients had a severe exacerbation and 59.8% had a severe or moderate exacerbation; 90.4% of patients had fill for an ICS + LABA, LABA, or LAMA, or had an exacerbation prior to triple therapy.
The mean blood eosinophil count (n=3,109) during the baseline period was 336 ± 2422.8 cells/μL. Most patients (66.5%) had EOS ≥150 cells/μL and 20.2% of patients had high values, above 350 cells/μL.
Conclusions: This analysis shows that physicians are using MITT after use of other inhaled COPD maintenance therapies or in patients with risk for exacerbations, which is aligned with current COPD treatment strategies. Less than 10% of MITT use was in patients without prior treatment or exacerbation risk.
Funding: GSK, study HO-16-16350.
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