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A2502 - Medication Adherence and Persistence in Chronic Obstructive Pulmonary Disease (COPD) Patients on Triple Therapy in a US Commercially-Insured Population
Author Block: M. Bogart1, F. Laliberté2, M. S. Duh3, J. W. Wu2, G. Germain2, R. H. Stanford1; 1GlaxoSmithKline, Research Triangle Park, NC, United States, 2Groupe d’analyse, Ltée, Montréal, QC, Canada, 3Analysis Group, Inc., Boston, MA, United States.
RATIONALE There are limited real-world studies on adherence patterns of chronic obstructive pulmonary disease (COPD) patients using multiple inhaler triple therapy (MITT). This study aimed to describe baseline characteristics, adherence, and persistence patterns following the initiation of MITT. METHODS Longitudinal, retrospective cohort analysis using a large nationally representative database including pharmacy and medical claims data. Subjects with COPD (ICD-9/10 codes), age ≥40, and on MITT, defined as having ≥1 overlapping days’ supply of three COPD medications (inhaled corticosteroids [ICS], long-acting beta-agonists [LABA], and long-acting muscarinic-antagonists [LAMA]) between January 2011 to September 2016 were identified. Adherence (proportion of days covered [PDC]) was calculated for each patient as the total number of days on therapy for all three triple therapy components (ICS, LABA, and LAMA), starting from the index date, divided by a fixed time-interval, and measured for 12 months. In addition, the PDC for each component in the MITT regimen was calculated separately and a PDC ≥0.8 for all three components was used to classify patients as adherent. RESULTS A total of 14,635 MITT users were identified. Mean age was 62 years, 57% were male, and had a mean Charlson Comorbidity Index score of 2.4. The mean PDC based on overlapping days’ supply for MITT at 12 months was 37% (0.37 ± 0.30 [0.26]) while the mean PDC for the ICS/LABA component was 49% (0.49 ± 0.31 [0.47]) and the mean PDC for the LAMA component was 54% (0.54 ± 0.33 [0.56]). The proportion of MITT users considered adherent (PDC ≥0.8) was 14% at 12 months. Proportion adherent to each component of triple therapy (ICS, LABA, LAMA) was 25%, 25%, and 34%, respectively. Allowing for a 30-day gap of therapy, 87% of MITT users discontinued therapy over the 12-month follow-up. CONCLUSIONS This study on adherence and persistence to MITT in a real-world setting showed that patients with COPD had low adherence and persistence to MITT over a 12-month period. When comparing MITT to a single inhaler therapy (ICS/LABA or LAMA) descriptively, mean PDC was higher for the single inhaler component of the MITT. Given the low adherence and persistence to MITT, minimizing the complexity of the triple therapy regimen by reducing the number of inhaler may be warranted.