Rates of escalation to triple COPD therapy among incident users of LAMA and LAMA/LABA

• Published in: Respiratory medicine 2018-06, Vol.139, p.65-71
• Main Authors: Hahn, Beth, Hull, Michael, Blauer-Peterson, Cori, Buikema, Ami R., Ray, Riju, Stanford, Richard H.
• Format: Article
• Language: English
• Subjects: Acetylcholine receptors (muscarinic); Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Adrenergic beta-2 Receptor Agonists - administration & dosage; Adrenergic beta-2 Receptor Agonists - therapeutic use; Aged; Aged, 80 and over; Benzyl Alcohols - administration & dosage; Benzyl Alcohols - therapeutic use; Chlorobenzenes - administration & dosage; Chlorobenzenes - therapeutic use; Chronic obstructive pulmonary disease; Combination therapy; Comorbidity; Confidence intervals; COPD; Corticosteroids; Costs; Delayed-Action Preparations; Drug Therapy, Combination; Female; Fixed-dose dual bronchodilators; Humans; Inhaled corticosteroids; LAMA/LABA; Long-acting bronchodilators; Lung diseases; Male; Middle Aged; Muscarinic Antagonists - administration & dosage; Muscarinic Antagonists - therapeutic use; Obstructive lung disease; Patients; Pharmacy; Pulmonary Disease, Chronic Obstructive - drug therapy; Quality of life; Quinuclidines - administration & dosage; Quinuclidines - therapeutic use; Retrospective Studies; Therapy; Tiotropium Bromide - administration & dosage; Tiotropium Bromide - therapeutic use; Treatment Outcome
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2018.04.014

Improved outcomes have been reported for patients with chronic obstructive pulmonary disease (COPD) receiving combination long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) therapy compared with LAMA monotherapy. However, little is known about the relative characteristics of these patients and their rates of escalation to triple therapy (TT, combining a LAMA, LABA, and inhaled corticosteroid). This study aimed to characterize patients initiating treatment with the LAMA tiotropium (TIO) and the fixed-dose LAMA/LABA combination therapy umeclidinium/vilanterol (UMEC/VI), and to compare rates of escalation to TT between patients receiving these therapies. Retrospective study of patients with COPD enrolled in a US health insurance plan during 2013–2015 and newly initiated on TIO or UMEC/VI. Patients were ≥40 years of age at index (date of therapy initiation) with continuous enrollment for 12 months pre-index and ≥30 days post-index. LAMA users were propensity score matched 1:1 to LAMA/LABA users, with TT initiation rates reported by cohort using pharmacy claims. 35,357 patients initiating on TIO and 2407 patients initiating on UMEC/VI were identified. After propensity score matching, the rate of TT initiation was significantly higher in new TIO users (n = 1320) than in new UMEC/VI users (n = 1320) (0.92 vs 0.49 per 100 months of exposure, respectively; p