Introduction: Previous real-world evidence suggests that prompt versus delayed initiation of single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following an exacerbation results in improved clinical outcomes for patients with chronic obstructive pulmonary disease (COPD). This prior study was conducted in the first 2 years following FF/UMEC/VI approval, representing early trends. The current updated analysis aims to further elucidate the real-world evidence for FF/UMEC/VI.
Methods: This was a retrospective cohort study using the IQVIA PharMetrics® Plus database. Patients with COPD initiating SITT with FF/UMEC/VI within 6 months of an exacerbation (index date) were classified as prompt (≤ 30 days following exacerbation) or delayed (31-180 days) initiators. The baseline period comprised the 12 months prior to index. Inverse probability of treatment weighting was used to balance differences in baseline characteristics between cohorts. COPD exacerbations, hospital readmission rates, and healthcare costs were compared between cohorts post-index.
Results: Overall, 5421 patients (prompt, 2057; delayed, 3364) were included. After weighting, baseline characteristics were well balanced between cohorts. For up to 12 months post-index, prompt initiators of FF/UMEC/VI had significantly lower rates of exacerbations per person-year versus delayed initiators (0.74 vs. 1.06; rate ratio 0.70, 95% confidence interval [CI] 0.64-0.77; P < 0.001). A 1-day delay in FF/UMEC/VI initiation was associated with a 0.31% increase in the rate of exacerbations. At 90 days post-index, Kaplan-Meier rates of all-cause (hazard ratio [HR] 0.62, 95% CI 0.45-0.86; P = 0.004) and COPD-related (HR 0.58, 95% CI 0.35-0.98; P = 0.042) hospital readmissions were significantly lower in the prompt versus delayed cohort. Total COPD-related healthcare costs per person per year were significantly lower for patients in the prompt versus delayed cohort.
Conclusion: Healthcare providers should consider the positive impact of prompt FF/UMEC/VI initiation on exacerbation rate, hospital readmission rate, and costs when treating patients with COPD at risk of exacerbations.
Keywords: Chronic obstructive pulmonary disease; Exacerbation; Fluticasone furoate/umeclidinium/vilanterol; Healthcare costs; Hospital readmission; Single-inhaler triple therapy.
Triple therapy (a combination of three medicines) is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience short-term worsening of symptoms (or COPD attacks). The optimum time for patients who may benefit from triple therapy to initiate their new medication following a COPD attack is still being investigated. This study assesses the effect of initiating treatment with triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) sooner rather than later following a COPD attack. Patients with COPD who experienced a COPD attack and went on to initiate therapy with FF/UMEC/VI were split into two groups—those who initiated FF/UMEC/VI within 30 days of their COPD attack, and those who initiated FF/UMEC/VI between 31 and 180 days following their COPD attack. Patients who initiated FF/UMEC/VI sooner (within 30 days of their original COPD attack) had fewer COPD attacks in the following year compared with patients who initiated FF/UMEC/VI later. Among those who initiated FF/UMEC/VI sooner, there were also fewer patients with hospital readmission, and lower healthcare costs resulting from COPD, compared with patients who initiated FF/UMEC/VI later. The results of this study suggest that healthcare providers should consider prescribing FF/UMEC/VI for patients with COPD as soon as possible following a COPD attack, rather than delaying the start of therapy, and may encourage patients to start taking FF/UMEC/VI sooner rather than later following a COPD attack.
© 2024. The Author(s).