Persistence and Adherence to ICS/LABA Drugs in UK Patients with Asthma: A Retrospective New-User Cohort Study

Abstract

Introduction: Asthma is associated with significant economic burden. Inhaled corticosteroid and long-acting beta 2-agonist (ICS/LABA) combination therapies are considered mainstays of treatment. We describe real-world use of ICS/LABAs by comparing treatment persistence and adherence among patients with asthma in the United Kingdom initiating fluticasone furoate/vilanterol (FF/VI) versus budesonide/ formoterol (BUD/FM) or beclometasone dipropionate/formoterol (BDP/FM). Methods: A retrospective new-user active comparator database study was conducted in the IQVIA Medical Research Database. Propensity score (PS) matching was performed for FF/VI versus BUD/FM, and FF/VI versus BDP/ FM. The primary objective was to compare patient treatment persistence (time to discontinuation), while secondary objectives included assessing adherence (mean proportion of days covered [PDC] with medication in the study period) and the proportions of patients achieving C 50% and C 80% PDC.

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“…Drug use was objectively measured and the proportion of individuals who were persistent in ICS/LABA use > 2 years was 69%. This is slightly better than a study of real-world use of ICS/LABA in UK asthma patients, which found a proportion of patient persistence between 53% and 69% after only 1 year [20]. This slightly better adherence could be due to the increased monitoring and reimbursement of treatment within the WTC program.…”

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“…Although treatment adherence was not directly measured, the results of this study could be at least partially attributed to the simplified (once-a-day) dosing of FF/VI 100/25 mcg ( 24 (26). Poor treatment adherence is associated with a greater risk of uncontrolled asthma (4), with improved adherence having a positive impact on symptoms, as described by Parimi et al in a retrospective, new-user, active comparator database study (24). A previous retrospective longitudinal analysis using US-based medical and pharmacy claims data on 12,907 patients with asthma reported that a 25% improvement in medication adherence was associated with a 10% reduction in the odds of receiving SABA, and a 10% reduction in the odds of requiring an asthma-related ED visit or hospitalization (27).…”

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“…This include cost-effectiveness ( 16 ), cost-utility ( 17 ), asthma control ( 18 ) and time to the first exacerbation ( 19 ). A non-negligible aspect of the use of combined inhalers is their positive effect on the patient’s compliance, largely resulting from an increased convenience with the combination inhaler ( 20 ).…”