哮喘管理中单一吸入器与多种吸入器三联疗法的依从性和持久性。

Adherence and Persistence to Single-Inhaler Versus Multiple-Inhaler Triple Therapy for Asthma Management.

机构信息

University of Wisconsin School of Medicine and Public Health, Madison, Wisc.

US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC.

出版信息

J Allergy Clin Immunol Pract. 2022 Nov;10(11):2904-2913.e6. doi: 10.1016/j.jaip.2022.06.010. Epub 2022 Jun 22.

DOI:10.1016/j.jaip.2022.06.010

PMID:35752431

Abstract

BACKGROUND

Treatment guidelines recommend triple therapy for patients with asthma who remain uncontrolled on inhaled corticosteroid/long-acting β-agonist therapy. Previously, triple therapy was only available via multiple inhalers. Single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is approved as maintenance treatment for asthma; however, real-world information on adherence and persistence is limited.

OBJECTIVE

To compare adherence and persistence among adult patients with asthma receiving single-inhaler FF/UMEC/VI versus multiple-inhaler triple therapy (MITT) in the United States.

METHODS

This retrospective cohort study used IQVIA PharMetrics Plus data to evaluate patients with asthma who initiated once-daily FF/UMEC/VI 100/62.5/25 mcg or MITT between September 18, 2017, and September 30, 2019. Inverse probability weighting and multivariable regression adjusted for differences in characteristics between the FF/UMEC/VI and MITT cohorts. Adherence was assessed using proportion of days covered (PDC) and proportion of patients achieving PDC ≥0.8 and PDC ≥0.5. Non-persistence was identified as a >45-day gap between fills.

RESULTS

The study included 1396 FF/UMEC/VI and 5115 MITT initiators. Three months after initiation, FF/UMEC/VI users had significantly higher mean PDC versus MITT users (0.68 vs 0.59; P < .001) and 31% more likely to be adherent (PDC ≥0.8; 40.6% vs 31.3%; adjusted risk ratio [95% confidence interval (CI)]: 1.31 [1.13-1.54]; P < .001). Similar patterns were observed at 6 and 12 months post initiation. In addition, FF/UMEC/VI users were 49% more likely to persist at 12 months than MITT users (25.9% vs 15.1%, adjusted hazard ratio [95% CI]: 1.49 [1.39-1.60]; P < .001).

CONCLUSIONS

Patients with asthma initiating triple therapy with FF/UMEC/VI had significantly better adherence and persistence compared with MITT initiators.

摘要

背景

对于吸入皮质激素/长效β-激动剂治疗控制不佳的哮喘患者，治疗指南推荐三联疗法。此前，三联疗法仅可通过多种吸入器使用。氟替卡松乌美溴铵维兰特罗（FF/UMEC/VI）单吸入器已被批准用于哮喘的维持治疗；然而，关于依从性和持久性的真实世界信息有限。

目的

比较美国接受单吸入器 FF/UMEC/VI 与多吸入器三联疗法（MITT）的哮喘成年患者的依从性和持久性。

方法

这项回顾性队列研究使用 IQVIA PharMetrics Plus 数据，评估了 2017 年 9 月 18 日至 2019 年 9 月 30 日期间每日一次接受氟替卡松乌美溴铵维兰特罗 100/62.5/25 mcg 或 MITT 治疗的哮喘患者。采用逆概率加权和多变量回归调整 FF/UMEC/VI 和 MITT 队列之间的特征差异。通过用药天数比例（PDC）和达到 PDC≥0.8 和 PDC≥0.5 的患者比例评估依从性。非持久性定义为两次用药之间的间隔超过 45 天。

结果

研究纳入了 1396 例 FF/UMEC/VI 和 5115 例 MITT 初治患者。治疗开始后 3 个月，FF/UMEC/VI 使用者的平均 PDC 显著高于 MITT 使用者（0.68 比 0.59；P＜0.001），且达到 PDC≥0.8 的患者比例高 31%（40.6%比 31.3%；调整风险比[95%置信区间（CI）]：1.31[1.13-1.54]；P＜0.001）。在治疗开始后 6 个月和 12 个月时也观察到类似的模式。此外，FF/UMEC/VI 使用者在 12 个月时的持久性比 MITT 使用者高 49%（25.9%比 15.1%，调整的危险比[95%CI]：1.49[1.39-1.60]；P＜0.001）。