<p>Impact of Single Combination Inhaler versus Multiple Inhalers to Deliver the Same Medications for Patients with Asthma or COPD: A Systematic Literature Review</p>

Abstract

With increasing choice of medications and devices for asthma and chronic obstructive pulmonary disease (COPD) treatment, comparative evidence may inform treatment decisions. This systematic literature review assessed clinical and economic evidence for using a single combination inhaler versus multiple inhalers to deliver the same medication for patients with asthma or COPD. In 2016, Embase, PubMed and the Cochrane library were searched for publications reporting studies in asthma or COPD comparing a single-inhaler combination medicine with multiple inhalers delivering the same medication. Publications included English-language articles published since 1996 and congress abstracts since 2013. Clinical, economic and adherence endpoints were assessed. Of 2031 abstracts screened, 18 randomized controlled trials (RCTs) in asthma and four in COPD, nine retrospective and three prospective observational studies in asthma, and four observational studies in COPD were identified. Of these, five retrospective and one prospective study in asthma, and two retrospective studies in COPD reported greater adherence with a single inhaler than multiple inhalers. Nine observational studies reported significantly (n=7) or numerically (n=2) higher rates of adherence with single-versus multiple-inhaler therapy. Economic analyses from retrospective and prospective studies showed that use of single-inhaler therapies was associated with reduced healthcare resource use (n=6) and was cost-effective (n=5) compared with multiple-inhaler therapies. Findings in 18 asthma RCTs and one prospective study reporting lung function, and six RCTs reporting exacerbation rates, showed no significant differences between a single inhaler and multiple inhalers. This was in contrast to several observational studies reporting reductions in healthcare resource use or exacerbation events with single-inhaler treatment, compared with multiple inhalers. Retrospective and prospective studies showed that single-inhaler use was associated with decreased healthcare resource utilization and improved cost-effectiveness compared with multiple inhalers. Lung function and exacerbation rates were mostly comparable in the RCTs, possibly due to study design.

INTREPID: single-versusmultiple-inhaler triple therapy for COPD in usual clinical practice

“…Triple therapy with inhaled corticosteroid (ICS), long-acting β 2 -agonist (LABA) and long-acting muscarinic antagonist (LAMA) for COPD has traditionally required use of multiple inhalers, sometimes several times per day [ 1 ]. However, patients’ persistence and adherence with COPD medication administered via multiple inhalers have been shown to be worse than with therapy administered via a single inhaler [ 2 , 3 ]. Reducing the number of inhalers required and frequency of use should improve treatment persistence and adherence, which could in turn improve clinical effectiveness and patient outcomes [ 4 , 5 ].…”

Single-inhaler triple vs single-inhaler dual therapy in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized control trials

“…Additionally, previous research has shown that COPD patients have a lower rate of adherence to treatment with multiple-inhaler therapy than single-inhaler therapy [ 32 , 33 ]. Single-inhaler therapy is simpler and thus may lead to better compliance and improved clinical outcomes in COPD patients [ 34 ] and therefore decrease healthcare resource utilization [ 7 , 35 ]. If these outcomes are achieved without increasing costs, this may reduce the economic and healthcare resource burden [ 6 ].…”

“…The Global Initiative for Obstructive Lung Disease (GOLD) management strategy recommends using ICS/LABA + LAMA in patients with persistent breathlessness, exercise limitation or persistent exacerbation, but it does not specify when to use single-inhaler triple therapy [ 4 ]. Single-inhaler triple therapy may be of benefit in patients with COPD by decreasing inhaler errors, improving adherence rates, and decreasing healthcare costs [ 5 – 7 ]. In some RCTs comparing triple therapy with dual therapy in COPD, there might be a bias resulting from the use of multiple inhaler devices.…”

Benefit/Risk Profile of Single-Inhaler Triple Therapy in COPD

“…80 Compared with single-inhaler use, the use of multiple inhalers has been shown to be associated with poorer persistence and adherence to COPD medication, which could, in turn, lead to poor symptom control, higher healthcare utilization and costs, and reductions in healthrelated quality of life. [82][83][84][85] The randomized, Phase IV effectiveness INTREPID study (NCT03467425) provides supporting evidence for the benefits of single-versus multiple-inhaler triple therapy. 86 The study evaluated SITT with FF/UMEC/VI versus multiple-inhaler triple therapy as a class over 24 weeks, in 3092 patients with symptomatic COPD and a history of exacerbations who were already receiving triple therapy or had a documented clinical indication for escalation from dual to triple therapy.…”