使用美国商业保险和医疗保险优势计划理赔数据的慢性阻塞性肺疾病患者对单吸入器三联疗法的依从性和持续性
Adherence and Persistence with Single-Inhaler Triple Therapy Among Patients with COPD Using Commercial and Medicare Advantage US Health Plan Claims Data.
作者信息
Young Corinne, Lee Lydia Y, DiRocco Kristi K, Germain Guillaume, Klimek Jacob, Laliberté François, Lejeune Dominique, Noorduyn Stephen G, Paczkowski Rosirene
机构信息
Association of Pulmonary Advanced Practice Providers and Clinical Services, Colorado Springs, CO, USA.
US Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, 19426-0989, USA.
出版信息
Adv Ther. 2025 Feb;42(2):830-848. doi: 10.1007/s12325-024-03055-w. Epub 2024 Dec 5.
INTRODUCTION
Previously, adherence and persistence to treatment have been shown to improve outcomes among patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate adherence and persistence to single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; one inhalation, once-daily) compared with budesonide/glycopyrrolate/formoterol fumarate (BUD/GLY/FOR; two inhalations, twice-daily) among patients with COPD in the USA.
METHODS
This retrospective weighted cohort study used claims data from the IQVIA PharMetrics Plus Database from October 1, 2019 to March 31, 2023, to identify patients with COPD newly initiating FF/UMEC/VI or BUD/GLY/FOR. Index date was the first pharmacy claim for FF/UMEC/VI or BUD/GLY/FOR on or after October 1, 2020. The longest follow-up period was 12 months. Inverse probability of treatment weighting was used to balance baseline characteristics between cohorts. Adherence was measured as mean proportion of days covered (PDC); the proportion of patients with PDC ≥ 0.5 and PDC ≥ 0.8 was also assessed. Persistence was assessed as time to treatment discontinuation using Kaplan-Meier rates.
RESULTS
Overall, 8912 and 2685 patients were included in the FF/UMEC/VI and BUD/GLY/FOR cohorts, respectively. After weighting, mean age and proportion of patients with Medicare Advantage insurance was 64.62 years and 40.0% in the FF/UMEC/VI cohort and 63.96 years and 36.1% in the BUD/GLY/FOR cohort. At 6 months post-index, mean PDC was greater in the FF/UMEC/VI versus the BUD/GLY/FOR cohort (0.65 versus 0.59; P < 0.001). A significantly greater proportion of patients in the FF/UMEC/VI versus the BUD/GLY/FOR cohort had PDC ≥ 0.8 (45.6% versus 34.5%; P < 0.001) and PDC ≥ 0.5 (71.8% versus 64.3%; P < 0.001). Results were consistent at 12 months post-index. When a 30-day gap was used to define treatment discontinuation, the FF/UMEC/VI cohort had statistically significantly greater treatment persistence versus the BUD/GLY/FOR cohort at all time points.
CONCLUSION
In this study, patients initiating FF/UMEC/VI had significantly greater adherence and persistence to treatment than patients initiating BUD/GLY/FOR.
引言
此前已有研究表明，坚持治疗可改善慢性阻塞性肺疾病（COPD）患者的预后。本研究旨在评估美国COPD患者中，使用糠酸氟替卡松/乌美溴铵/维兰特罗（FF/UMEC/VI；每日一次吸入）单吸入器三联疗法与布地奈德/格隆溴铵/富马酸福莫特罗（BUD/GLY/FOR；每日两次吸入）相比的依从性和持续性。
方法
这项回顾性加权队列研究使用了IQVIA PharMetrics Plus数据库中2019年10月1日至2023年3月31日的索赔数据，以确定新开始使用FF/UMEC/VI或BUD/GLY/FOR的COPD患者。索引日期为2020年10月1日或之后首次开具FF/UMEC/VI或BUD/GLY/FOR的药房索赔日期。最长随访期为12个月。采用治疗权重的逆概率来平衡队列之间的基线特征。依从性通过平均覆盖天数比例（PDC）来衡量；还评估了PDC≥0.5和PDC≥0.8的患者比例。持续性通过使用Kaplan-Meier率评估治疗中断时间来评估。
结果
总体而言，FF/UMEC/VI队列和BUD/GLY/FOR队列分别纳入了8912例和2685例患者。加权后，FF/UMEC/VI队列的平均年龄和拥有医疗保险优势保险的患者比例分别为64.62岁和40.0%，BUD/GLY/FOR队列分别为63.96岁和36.1%。在索引后6个月，FF/UMEC/VI队列的平均PDC高于BUD/GLY/FOR队列（0.65对0.59；P<0.001）。FF/UMEC/VI队列中PDC≥0.8（45.6%对34.5%；P<0.001）和PDC≥0.5（71.8%对64.3%；P<0.001）的患者比例显著高于BUD/GLY/FOR队列。索引后12个月的结果一致。当使用30天的间隔来定义治疗中断时，FF/UMEC/VI队列在所有时间点的治疗持续性在统计学上显著高于BUD/GLY/FOR队列。
结论
在本研究中，开始使用FF/UMEC/VI的患者比开始使用BUD/GLY/FOR的患者具有显著更高的治疗依从性和持续性。
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