Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center North, PO Box 9510, Morgantown, WV 26506-9510. Email:
Am J Manag Care. 2021 Nov;27(11):463-470. doi: 10.37765/ajmc.2021.88773.
To examine the impact of initial maintenance therapy (IMT) type (inhaled corticosteroid [ICS] vs fixed-dose combination of ICS and long-acting β agonist [ICS/LABA]) on trajectories of adherence among older adults (≥ 65 years) with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO).
We used a longitudinal, retrospective cohort design.
This study used a cohort of older adults with ACO using longitudinal data from a 10% sample of Optum's Deidentified Clinformatics Data Mart. We adopted group-based trajectory modeling to identify medication adherence trajectories over 12 months. Multinomial logistic regressions were used to evaluate the unadjusted and adjusted associations of IMT medication and adherence trajectory categories. All analyses accounted for treatment option selection bias with inverse probability treatment weighting.
Of 1555 individuals, 73% of the sample used ICS/LABA for IMT. Four medication adherence trajectories were observed regardless of regimen: (1) persistent high adherence (12.0%), (2) progression to high adherence (20.8%), (3) progression to low adherence (10.5%), and (4) persistent low adherence (56.7%). Those who were initiated on ICS/LABA were less likely to have persistent low adherence (unadjusted odds ratio [OR], 0.44; 95% CI, 0.29-0.67) compared with those initiated on ICS monotherapy when "persistent high adherence" was used as the reference group. The relationship remained significant in adjusted regressions (adjusted OR, 0.38; 95% CI, 0.24-0.59).
Real-world evidence suggests that using ICS/LABA for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy.
研究初始维持治疗（IMT）类型（吸入皮质类固醇[ICS]与 ICS 和长效β激动剂[ICS/LABA]固定剂量联合）对同时患有哮喘和慢性阻塞性肺疾病（COPD）（称为哮喘-COPD 重叠[ACO]）的老年患者（≥65 岁）依从性轨迹的影响。
我们采用了纵向回顾性队列设计。
本研究使用了来自 Optum 的 Deidentified Clinformatics Data Mart 的 10%样本的老年 ACO 患者队列，使用纵向数据。我们采用基于群组的轨迹建模来确定 12 个月内的药物依从性轨迹。采用多项逻辑回归评估 IMT 药物和依从性轨迹类别的未调整和调整关联。所有分析均考虑了治疗选择偏倚，采用逆概率治疗加权。
在 1555 名患者中，73%的患者使用 ICS/LABA 进行 IMT。无论方案如何，都观察到四种药物依从性轨迹：（1）持续高依从性（12.0%），（2）进展为高依从性（20.8%），（3）进展为低依从性（10.5%）和（4）持续低依从性（56.7%）。与以“持续高依从性”为参考组的ICS 单药治疗相比，起始使用 ICS/LABA 的患者持续低依从性的可能性较低（未调整比值比[OR]，0.44；95%置信区间[CI]，0.29-0.67）。在调整后的回归中，这种关系仍然显著（调整后的 OR，0.38；95%CI，0.24-0.59）。
真实世界的证据表明，与 ICS 单药治疗相比，在患有 ACO 的老年患者中，使用 ICS/LABA 进行 IMT 可能会随着时间的推移降低持续低依从性的可能性。
