Characteristics of Users and New Initiators of Single- and Multiple-Inhaler Triple Therapy for Chronic Obstructive Pulmonary Disease in Germany.

Purpose: To assess patient characteristics of users and new initiators of triple therapy for chronic obstructive pulmonary disease (COPD) in Germany.
Patients and Methods: Retrospective cohort study of patients with COPD and ≥1 prescription for single-inhaler triple therapy (SITT; fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or beclomethasone dipropionate/glycopyrronium bromide/formoterol [BDP/GLY/FOR]) or multiple-inhaler triple therapy (MITT), using data from the AOK PLUS German sickness fund (1 January 2015-31 December 2019). The index date was the first date of prescription for FF/UMEC/VI or BDP/GLY/FOR (SITT users), or the first date of overlap of inhaled corticosteroid, long-acting β ₂ -agonist, and long-acting muscarinic antagonist (MITT users). Two cohorts were defined: the prevalent cohort included all identified triple therapy users; the incident cohort included patients newly initiating triple therapy for the first time (no prior use of MITT or SITT in the last 2 years). Patient characteristics and treatment patterns were assessed on the index date and during the 24-month pre-index period.
Results: In total, 18,630 patients were identified as prevalent triple therapy users (MITT: 17,945; FF/UMEC/VI: 700; BDP/GLY/FOR: 908; non-mutually exclusive) and 2932 patients were identified as incident triple therapy initiators (MITT: 2246; FF/UMEC/VI: 311; BDP/GLY/FOR: 395; non-mutually exclusive). For both the prevalent and incident cohorts, more than two-thirds of patients experienced ≥1 moderate/severe exacerbation in the preceding 24 months; in both cohorts more BDP/GLY/FOR users experienced ≥1 moderate/severe exacerbation, compared with FF/UMEC/VI and MITT users. Overall, 97.9% of prevalent triple therapy users and 86.4% of incident triple therapy initiators received maintenance treatment in the 24-month pre-index period.
Conclusion: In a real-world setting in Germany, triple therapy was most frequently used after maintenance therapy in patients with recent exacerbations, in line with current treatment recommendations.
Competing Interests: Kai-Michael Beeh is a full-time employee of Insaf Respiratory Research Institute. He has received personal or institutional compensation for services on advisory boards or consulting for AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Chiesi, Elpen, GSK, Mundipharma, Novartis, Pohl Boskamp, Sanofi, sterna, and Zentiva, and compensation for speaker activities in scientific meetings supported by AstraZeneca, Berlin Chemie, Boehringer Ingelheim, ERT, GSK, Novartis, Pfizer, Pohl Boskamp, Sanofi, and Teva, all outside the submitted work. The institution has received compensation for design and performance of clinical trials from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Parexel, Pearl Therapeutics, sterna, and Zentiva. Kieran J Rothnie, Jing Claussen, Chris Compton, and Afisi S Ismaila are employees of and/or hold stocks/shares in GSK. Afisi S Ismaila is also an unpaid part-time member of the McMaster University faculty. Alexandrosz Czira was an employee of GSK at the time of the study and now works for Gedeon Richter PLC. Fränce Hardtstock and Rachel K Knapp participated in this study as employees of Cytel/Ingress-Health. Cytel/Ingress-Health received funding from GSK to conduct the study. Thomas Wilke reports grants from GSK and Cytel/Ingress-Health during the conduct of the study and grants from Apontis, Janssen, and Pfizer outside the submitted work. Thomas Wilke received honoraria and other financial support from Cytel Inc., which does studies with all major pharmaceutical companies. The authors report no other conflicts of interest in this work.
(© 2024 Beeh et al.)