Treatment Patterns and Disease Burden Associated with Multiple-Inhaler Triple-Therapy Use in Asthma

Adherence and Persistence to Single-Inhaler Versus Multiple-Inhaler Triple Therapy for Asthma Management

“…1,2,11,39 Moreover, better adherence may also translate into economic benefits, as highlighted by the observational study in the United States showing that adherent patients (PDC !80%) had lower medical costs and asthma-related exacerbation costs, although total costs were numerically higher in the adherent group, reflecting, as expected, higher pharmacy costs among adherent patients (PDC !80%). 22 Although significant improvements relative to MITT were observed, the rates of adherence and persistence to FF/UMEC/VI in this study are still relatively low and decreased over follow-up. This heavily burdened, moderate/severe population of tripletherapyeeligible patients with asthma would clearly benefit from the improved lung function, symptom control, and lower asthma exacerbations rates known to be associated with high adherence.…”

“…29,36,37 This suggests that once-daily FF/UMEC/VI overcomes the complexities of using multiple inhalers with different dosing regimens in triple therapy. 2,11,22 A predictive modeling study in Spain reported that a 20% increase in the use of SITT in patients with COPD on MITT could potentially increase the proportion of adherent patients up to 52%. 38 In this study, approximately 41% of patients were adherent to single-inhaler FF/UMEC/VI at 3 months of follow-up, though this rate dropped to 25% after 12 months of follow-up.…”

“…A real-world study in the United States among patients with asthma found rates of adherence and persistence to MITT similar to those observed in this study, with a mean (SD) PDC of 0.31 (0.27) at 12 months after initiation and 12% of patients remaining on MITT at 12 months. 22 Suzuki et al 21 who initiated MITT in Japan. Adherence and persistence rates were slightly higher in the asthma-only cohort than those reported here, but still generally low (mean [SD] PDC of 0.51 [0.36] over 12 months, and 38.5% of patients persistent to MITT at 12 months); 21 however, the sample size was considerably smaller than the present study.…”

“…2 Real-world observational studies in the United States and Japan reported low adherence to, and persistence with MITT among patients with asthma requiring triple therapy. 21,22 The US study also reported a substantial disease burden (high HRU and exacerbation rates) associated with MITT. 22 A fixed-dose combination of fluticasone furoate (FF), umeclidinium (UMEC), and vilanterol (VI) (FF/UMEC/VI 100/62.5/25 mcg), administered once daily via a single inhaler (ELLIPTA dry-powder inhaler), 23 was approved by the Food and Drug Administration (FDA) for chronic obstructive pulmonary disease (COPD) on September 18, 2017, and September 9, 2020, for adults with asthma.…”

“…21,22 The US study also reported a substantial disease burden (high HRU and exacerbation rates) associated with MITT. 22 A fixed-dose combination of fluticasone furoate (FF), umeclidinium (UMEC), and vilanterol (VI) (FF/UMEC/VI 100/62.5/25 mcg), administered once daily via a single inhaler (ELLIPTA dry-powder inhaler), 23 was approved by the Food and Drug Administration (FDA) for chronic obstructive pulmonary disease (COPD) on September 18, 2017, and September 9, 2020, for adults with asthma. 23,24 FF/UMEC/VI is the first single-inhaler triple therapy (SITT) approved by the FDA for the management of both asthma and COPD, and is the only SITT available in the United States that is administered once daily.…”