A Real-World Analysis of Treatment Patterns and Clinical Characteristics Among Patients with COPD Who Initiated Multiple-Inhaler Triple Therapy in New Zealand

Abstract

Purpose Real-world data on maintenance treatment and prescription patterns provide insights into healthcare management among patients with chronic obstructive pulmonary disease (COPD), which benefits our understanding of current COPD treatment patterns in New Zealand. Methods We retrospectively analyzed real-world data from the HealthStat general practice database to evaluate treatment patterns among patients with COPD in New Zealand who initiated multiple-inhaler triple therapy (MITT): inhaled corticosteroid (ICS) + long-acting muscarinic antagonist + long-acting β 2 -agonist (LABA). Our main objective described treatment patterns (class, duration, modification, persistence, and adherence) and characteristics of patients with COPD initiating MITT between 1 May 2016 and 30 April 2017, with 12-months’ follow-up. We also assessed the number of patients receiving MITT between 2015 and 2017, among a larger patient population receiving long-acting bronchodilator and ICS-containing therapies. Results Of 6249 eligible patients, 421 (mean age 67.3 years; mean number exacerbations at baseline 1.8) initiated MITT: 59.1% received combination ICS/LABA therapy prior to MITT initiation, and median treatment duration prior to MITT initiation was 350 days. Overall, 33.5% of patients remained on index treatment for 12 months. Of the remaining patients who modified treatment (on average at 144.4 days), those who had a direct switch (24.9%) or retreatment (13.5%) remained on MITT, 19.7% of patients stepped down to mono/dual therapy, and 8.3% discontinued treatment. Mean (standard deviation) persistence to any MITT over 12 months was 47.3 (50.0), and 53.4% of patients were considered adherent to MITT. Total proportions of patients receiving long-acting bronchodilator therapy and MITT increased between 2015 and 2017. Conclusion Most patients with COPD in New Zealand who initiated MITT had characteristics appropriate for triple therapy prescription, suggesting prescription behavior among general practitioners was largely consistent with treatment guidelines. Our findings may help optimize treatment decisions, with a focus on improving long-term triple therapy persistence and adherence.

Clinical Characteristics, Treatment Persistence, and Outcomes Among Patients With COPD Treated With Single- or Multiple-Inhaler Triple Therapy: A Retrospective Analysis in Spain

“…In other retrospective observational analyses of databases, persistence rates in users of MITT for COPD are generally low, although definitions of persistence were variable. [26][27][28] Using an allowable treatment gap of no more than 30 days, analysis of a US claims database (IQVIA Adjudicated Health Plan Claims) found that 86% of patients discontinued treatment at 12 months. 26 A UK study, which analyzed electronic health records and hospital episodes in COPD patients, found that the duration of continuous MITT use at 12 months was 23.8%.…”

“…27 Finally, in a New Zealand study that evaluated a general practice database, mean persistence (defined as without a gap in an assumed 90-day supply) for COPD patients who initiated MITT was 47.3% at 12 months' follow-up. 28 Recent analysis of a US claims database (IQVIA) found that patients with COPD initiating a defined SITT regimen (fluticasone furoate/umeclidinium/ vilanterol) had better adherence and persistence compared with patients initiating MITT. 23 In our analysis, SITT was also associated with significant reductions in the use of health care resources, with consequent mean annual cost savings of V408 compared with MITT.…”

Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

“…The effectiveness of treatment evaluated in real-world studies can complement traditional RCTs by providing a comprehensive overview of treatments in routine clinical practice. Previous real-world studies usually selected one or two types of bronchodilators in mono, dual combination or triple combinations for analysis ( Kalhan et al, 2021 ; Sansbury et al, 2021 ; Xu et al, 2021 ), and some studies have compared the effect between open triple and closed triple therapy ( Ferguson et al, 2020 ; Huang et al, 2021 ). However, there is a lack of real-world data on the effects of the inhalation therapies including mono, dual combination and triple combination therapies among patients with symptomatic COPD in China.…”

Treatment patterns and cost of exacerbations in patients with chronic obstructive pulmonary disease using multiple inhaler triple therapy in South Korea

“…In this study, ICS/LABA was the most common regimen received during the baseline period prior to MITT initiation, followed by no maintenance treatment comprising any of the MITT components. This was also observed globally, where ICS/LABA was found to be the most common treatment before MITT in the UK, Germany, Italy and New Zealand; patients also commonly did not receive any maintenance treatment prior to MITT in France, Germany, Italy and New Zealand [ 14 , 23 ]. While the latter practice (i.e., initiating MITT for patients who were not on any maintenance treatment comprising any MITT component) is inconsistent with the step-up approach from either LABA/LAMA or ICS/LABA outlined in the GOLD 2017 Report, the tendency to initiate MITT in the first-line setting has been observed by clinical experts in South Korea.…”

“…Similarly, patients may also have been diagnosed at a later and more severe stage, warranting initiation of MITT in the first-line setting, as was observed by Xu et al . , who reported that 23% of patients in New Zealand were not on previous therapy prior to MITT initiation, and hypothesized that diagnosis may have been delayed until a late stage before MITT initiation [ 23 ]. In addition, the cost barrier for prescription of MITT is low in South Korea due to the low cost of medications or existing reimbursement programs, making the receipt of MITT easily achievable for most of the population.…”