Lin Ling, Liu Cong, Cheng Wei, Song Qing, Zeng Yuqin, Li Xin, Deng Dingding, Liu Dan, Chen Yan, Cai Shan, Chen Ping
Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China.
Front Pharmacol. 2023 Mar 21;14:1147985. doi: 10.3389/fphar.2023.1147985. eCollection 2023.
This study sought to compare treatment persistence, adherence, and risk of exacerbation among patients with COPD treated with single-inhaler triple therapy (SITT) and multiple-inhaler triple therapy (MITT) in the Chinese population. This was a multicenter, prospective observational study. Patients with COPD from ten hospitals in Hunan and Guangxi provinces in China were recruited from 1 January 2020 to 31 November 2021 for the study and were followed up for one year. Treatment persistence, adherence, and exacerbation rates during the 12-month follow-up were analyzed in COPD patients treated with SITT and MITT. A total of 1,328 patients were enrolled for final analysis, including 535 (40.3%) patients treated with SITT and 793 (59.7%) treated with MITT. Of these patients, the mean age was 64.9 years and most patients were men. The mean CAT score was 15.2 ± 7.1, and the median (IQR) FEV1% was 54.4 (31.2). The SITT group had a higher mean CAT score, more patients with mMRC >1, and lower mean FEV1% and FEV1/FVC than the MITT patients. Moreover, the proportion of patients with ≥1 exacerbation in the previous year was higher in the SITT cohort. SITT patients had, compared to MITT patients, a higher proportion of adherence (proportion of days covered, PDC) ≥0.8 (86.5% vs. 79.8%; = 0.006), higher treatment persistence [HR: 1.676 (1.356-2.071), < 0.001], lower risk of moderate-to-severe exacerbation [HR: 0.729 (0.593-0.898), = 0.003], and severe exacerbation [HR: 0.675 (0.515-0.875), = 0.003], as well as reduced all-cause mortality risk [HR: 0.475 (0.237-0.952), = 0.036] during the 12-month follow-up. Persistence was related to fewer future exacerbations and mortality than non-persistence in the SITT and MITT groups. Patients with COPD treated with SITT showed improved treatment persistence and adherence, as well as a reduction in the risk of moderate-to-severe exacerbation, severe exacerbation, and mortality compared to patients treated with MITT in the Chinese population. : https://www.chictr.org.cn/, identifier ChiCTR-POC-17010431.
本研究旨在比较中国人群中接受单吸入器三联疗法（SITT）和多吸入器三联疗法（MITT）治疗的慢性阻塞性肺疾病（COPD）患者的治疗持续性、依从性和急性加重风险。这是一项多中心前瞻性观察性研究。2020年1月1日至2021年11月31日，从中国湖南和广西两省的十家医院招募COPD患者进行该研究，并随访一年。分析了接受SITT和MITT治疗的COPD患者在12个月随访期间的治疗持续性、依从性和急性加重率。共有1328例患者纳入最终分析，其中535例（40.3%）接受SITT治疗，793例（59.7%）接受MITT治疗。这些患者的平均年龄为64.9岁，大多数患者为男性。平均CAT评分为15.2±7.1，FEV1%的中位数（IQR）为54.4（31.2）。与MITT患者相比，SITT组的平均CAT评分更高，mMRC>1的患者更多，平均FEV1%和FEV1/FVC更低。此外，SITT队列中前一年有≥1次急性加重的患者比例更高。与MITT患者相比，SITT患者的依从性（覆盖天数比例，PDC）≥0.8的比例更高（86.5%对79.8%；P=0.006），治疗持续性更高[HR：1.676（1.356 - 2.071），P<0.001]，中重度急性加重风险更低[HR：0.729（0.593 - 0.898），P=0.003]，重度急性加重风险更低[HR：0.675（0.515 - 0.875），P=0.003]，以及在12个月随访期间全因死亡风险降低[HR：0.475（0.237 - 0.952），P=0.036]。在SITT和MITT组中，持续性与未来较少的急性加重和死亡相关。在中国人群中，与接受MITT治疗的患者相比，接受SITT治疗的COPD患者的治疗持续性和依从性得到改善，中重度急性加重、重度急性加重和死亡风险降低。注册信息：https://www.chictr.org.cn/，标识符ChiCTR - POC - 17010431 。
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