美国慢性阻塞性肺疾病患者对每日一次单吸入器与多吸入器三联疗法的依从性和持续性：一项真实世界研究。
Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study.
作者信息
Mannino David, Bogart Michael, Wu Benjamin, Germain Guillaume, Laliberté François, MacKnight Sean D, Jung Young, Stiegler Marjorie, Duh Mei Sheng
机构信息
Value Evidence and Outcomes, GlaxoSmithKline, 5 Moore Drive, PO Box 13398, Research Triangle Park, Durham, NC 27709-3398, USA.
Groupe d'analyse, Ltée, 1190 Avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7, Canada.
出版信息
Respir Med. 2022 Jun;197:106807. doi: 10.1016/j.rmed.2022.106807. Epub 2022 Mar 18.
BACKGROUND
Triple therapy comprising an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting β agonist (ICS/LAMA/LABA) is recommended for chronic obstructive pulmonary disease (COPD) patients at risk of exacerbation. Multiple-inhaler triple therapy (MITT) is associated with poor adherence and persistence; however, these outcomes have not been evaluated for single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).
METHODS
This retrospective analysis of the IQVIA PharMetrics Plus claims database identified patients with COPD initiating triple therapy between 18 September 2017 and 30 June 2019. The first date of single-inhaler FF/UMEC/VI dispensing, or first day of overlapping ICS, LAMA, and LABA medications for MITT users, defined the index date. Patients were ≥40 years, had ≥12 months of continuous insurance coverage pre-index (baseline) and ≥6 months' coverage post-index; those with MITT during baseline were excluded. Inverse probability weighting was used to balance baseline characteristics. Adherence was assessed using proportion of days covered (PDC) and was evaluated using linear and log-binomial models. Persistence (non-persistence identified as >30-day gap between fills) was evaluated using Cox models.
RESULTS
9942 patients (FF/UMEC/VI: 2782; MITT: 7160) were included. Adherence was significantly higher for FF/UMEC/VI versus MITT users (mean PDC, 0.66 vs. 0.48; p < 0.001), and FF/UMEC/VI users were twice as likely to be adherent (PDC ≥0.8) than MITT users (46.5% vs. 22.3%; risk ratio [95% CI]: 2.08 [1.85-2.30]; p < 0.001). After 12 months, significantly more FF/UMEC/VI users persisted on therapy than MITT users (35.7% vs. 13.9%; hazard ratio [95% CI]: 1.91 [1.81-2.01]; p < 0.001).
CONCLUSIONS
COPD patients initiating single-inhaler FF/UMEC/VI had significantly improved adherence and persistence compared with MITT.
背景
对于有急性加重风险的慢性阻塞性肺疾病（COPD）患者，推荐使用包含吸入性糖皮质激素、长效毒蕈碱拮抗剂和长效β受体激动剂（ICS/LAMA/LABA）的三联疗法。多吸入器三联疗法（MITT）与依从性和持续性较差有关；然而，对于单吸入器糠酸氟替卡松/乌美溴铵/维兰特罗（FF/UMEC/VI），尚未评估这些结果。
方法
这项对IQVIA PharMetrics Plus索赔数据库的回顾性分析确定了在2017年9月18日至2019年6月30日期间开始三联疗法的COPD患者。单吸入器FF/UMEC/VI配药的首日，或MITT使用者ICS、LAMA和LABA药物重叠使用的首日，定义为索引日期。患者年龄≥40岁，在索引前（基线）有≥12个月的连续保险覆盖，索引后有≥6个月的保险覆盖；排除基线期间使用MITT的患者。使用逆概率加权来平衡基线特征。使用覆盖天数比例（PDC）评估依从性，并使用线性和对数二项式模型进行评估。使用Cox模型评估持续性（非持续性定义为两次配药之间间隔>30天）。
结果
纳入9942例患者（FF/UMEC/VI：2782例；MITT：7160例）。FF/UMEC/VI使用者的依从性显著高于MITT使用者（平均PDC，0.66对0.48；p<0.001），FF/UMEC/VI使用者依从（PDC≥0.8）的可能性是MITT使用者的两倍（46.5%对22.3%；风险比[95%CI]：2.08[1.85 - 2.30]；p<0.001）。12个月后，坚持治疗的FF/UMEC/VI使用者显著多于MITT使用者（35.7%对13.9%；风险比[95%CI]：1.91[1.81 - 2.01]；p<0.001）。
结论
与MITT相比，开始使用单吸入器FF/UMEC/VI的COPD患者的依从性和持续性显著改善。
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