Jokšaitė Sandra, Wood Robert, Ismaila Afisi, Camidge Lucinda, Mizukami Akiko, Czira Alexandrosz, Massey Olivia, Yarita Masao, Compton Chris, Siddiqui Rad, Jennison Thomas, Ishii Takeo, Hashimoto Kenichi, Rothnie Kieran J
Value Evidence and Outcomes, R&D Global Medical, GlaxoSmithKline, London, UK.
Real-world Evidence, Adelphi Real World, Bollington, Cheshire, UK.
BMJ Open. 2024 Dec 4;14(12):e080864. doi: 10.1136/bmjopen-2023-080864.
To evaluate and compare medication adherence and persistence for patients newly initiating single-inhaler triple therapy (SITT) and multiple-inhaler triple therapy (MITT) for chronic obstructive pulmonary disease (COPD) in Japan.
Retrospective, new-user, active comparator, observational cohort study using inverse probability of treatment weighting.
Health insurance claims data from the Medical Data Vision Co., Ltd, hospital claims database.
Adults diagnosed with COPD at age ≥40 years newly initiating MITT or SITT (fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) or formoterol fumarate/budesonide/glycopyrronium) from 1 September 2019 to 31 July 2021.
The primary outcome was medication adherence compared between patients using SITT and MITT, assessed by the proportion of days covered ≥80%. Secondary outcomes included medication persistence (time from index treatment initiation to discontinuation) compared between patients using SITT and MITT and medication adherence compared before and after the switch in a subgroup of patients switching from MITT to SITT.
We included 2575 MITT and 2962 SITT users with similar baseline characteristics following weighting. The proportion of adherent patients was significantly greater for SITT versus MITT users at 6 months (19.7% vs 10.2%, p<0.0001), 12 months (6.0% vs 3.8%, p=0.0009) and 18 months (3.8% vs 1.4%, p<0.0001) post-index. Median persistence was also significantly higher for SITT versus MITT users (2.0 vs 1.0 months, p<0.001). Comparing specific SITT versus MITT, the proportion of adherent patients at each time point and median persistence was greater for FF/UMEC/VI. In patients switching from MITT to SITT (n=688), the proportion of adherent patients increased postswitch at the class level and for FF/UMEC/VI specifically.
Patients with COPD in Japan who were newly initiating SITT had greater medication adherence and persistence compared with those on MITT up to 18 months following initiation.
评估并比较日本慢性阻塞性肺疾病（COPD）患者新开始使用单吸入器三联疗法（SITT）和多吸入器三联疗法（MITT）时的药物依从性和持续性。
采用治疗权重逆概率的回顾性、新用户、活性对照观察性队列研究。
来自Medical Data Vision有限公司的医疗保险理赔数据、医院理赔数据库。
2019年9月1日至2021年7月31日期间，年龄≥40岁新开始使用MITT或SITT（糠酸氟替卡松/乌美溴铵/维兰特罗（FF/UMEC/VI）或富马酸福莫特罗/布地奈德/格隆溴铵）且被诊断为COPD的成年人。
主要结局是比较使用SITT和MITT的患者之间的药物依从性，通过覆盖天数比例≥80%进行评估。次要结局包括比较使用SITT和MITT的患者之间的药物持续性（从首次治疗开始到停药的时间），以及在从MITT转换为SITT的患者亚组中，转换前后的药物依从性比较。
加权后，我们纳入了2575名MITT使用者和2962名SITT使用者，他们具有相似的基线特征。在索引后6个月（19.7%对10.2%，p<0.0001）、12个月（6.0%对3.8%，p=0.0009）和18个月（3.8%对1.4%，p<0.0001）时，SITT使用者的依从性患者比例显著高于MITT使用者。SITT使用者的中位持续性也显著高于MITT使用者（2.0对1.0个月，p<0.001）。比较特定的SITT和MITT，FF/UMEC/VI在每个时间点的依从性患者比例和中位持续性更高。在从MITT转换为SITT的患者（n=688）中，转换后在类别水平以及特别是FF/UMEC/VI方面，依从性患者比例增加。
在日本，新开始使用SITT的COPD患者在开始后的18个月内，与使用MITT的患者相比，具有更高的药物依从性和持续性。
