Settipane Russell A, Germain Guillaume, Laliberté Francois, Mahendran Malena, Hilts Annalise, Duh Mei Sheng, Paczkowski Rosirene, Burrows Emmeline
Allergy & Asthma Center, East Providence, RI, USA.
Groupe d'analyse, Ltée., Montréal, QC, Canada.
Pulm Ther. 2025 Mar;11(1):81-100. doi: 10.1007/s41030-024-00285-9. Epub 2025 Jan 27.
Escalation to single- or multiple-inhaler triple therapy (SITT; MITT) is a recommended option for patients with asthma who remain uncontrolled by medium-dose inhaled corticosteroid/long-acting β-agonist; however, characterization of elderly users of triple therapy is limited. This real-world cohort study describes demographics and clinical characteristics of elderly patients with asthma with and without comorbid chronic obstructive pulmonary disease (COPD) who are new users of triple therapy, and asthma treatment patterns preceding triple therapy initiation.
This retrospective cohort study used administrative claims data from the Optum Clinformatics Data Mart database. Eligible patients were ≥ 65 years of age with asthma or with asthma and comorbid COPD who initiated either triple therapy with single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; 100/62.5/25 μg) or MITT between September 18, 2017 and September 30, 2020. Demographics, clinical characteristics, healthcare resource utilization, healthcare costs, and asthma treatment patterns were described in the 12-month period before triple therapy initiation (baseline period).
In total, 15,557 patients were included. Among FF/UMEC/VI initiators with asthma (N = 635) mean age was 73.3 years and 66.6% were female. During the baseline period, > 75% of patients used controller therapy, > 92% used rescue medications, 27.9% experienced ≥ 1 asthma-related exacerbation, with mean annual exacerbation rate of 0.42, and mean all-cause healthcare costs were $23,407. Patients with asthma initiating MITT and patients with asthma and comorbid COPD initiating FF/UMEC/VI or MITT had similar characteristics, healthcare resource utilization, healthcare costs, and asthma treatment patterns to FF/UMEC/VI initiators with asthma.
Triple therapy is often initiated following use of other asthma controller medications in real-world practice. Substantial rescue medication use and high disease and economic burden among this elderly patient population suggest that their asthma was not adequately controlled prior to triple therapy initiation. This retrospective study provides an early profile of elderly patients with asthma in the USA.
升级至单吸入器或多吸入器三联疗法（SITT；MITT）是推荐给那些使用中剂量吸入性糖皮质激素/长效β受体激动剂后仍未得到控制的哮喘患者的一种选择；然而，三联疗法老年使用者的特征描述有限。这项真实世界队列研究描述了新使用三联疗法的、患有和未患有慢性阻塞性肺疾病（COPD）合并症的老年哮喘患者的人口统计学和临床特征，以及三联疗法开始前的哮喘治疗模式。
这项回顾性队列研究使用了Optum临床信息数据集市数据库中的管理索赔数据。符合条件的患者年龄≥65岁，患有哮喘或患有哮喘合并COPD，在2017年9月18日至2020年9月30日期间开始使用单吸入器糠酸氟替卡松/乌美溴铵/维兰特罗（FF/UMEC/VI；100/62.5/25μg）三联疗法或MITT。在三联疗法开始前的12个月期间（基线期）描述了人口统计学、临床特征、医疗资源利用、医疗费用和哮喘治疗模式。
总共纳入了15557名患者。在开始使用FF/UMEC/VI的哮喘患者中（N = 635），平均年龄为73.3岁，66.6%为女性。在基线期，超过75%的患者使用控制疗法，超过92%的患者使用急救药物，27.9%的患者经历了≥1次哮喘相关加重，平均年加重率为0.42，平均全因医疗费用为23407美元。开始使用MITT的哮喘患者以及开始使用FF/UMEC/VI或MITT的哮喘合并COPD患者在特征、医疗资源利用、医疗费用和哮喘治疗模式方面与开始使用FF/UMEC/VI的哮喘患者相似。
在实际临床中，三联疗法通常是在使用其他哮喘控制药物之后开始的。在这一老年患者群体中，急救药物的大量使用以及较高的疾病和经济负担表明他们的哮喘在三联疗法开始前未得到充分控制。这项回顾性研究提供了美国老年哮喘患者的早期概况。
