Presentation (CTI)

OBJECTIVES: Despite the high cost of long-term chronic obstructive pulmonary disease (COPD) medications and the entry of two COPD inhalers in the Center for Medicare Services (CMS) Inflation Reduction Act (IRA) price negotiations, limited data describe the real-world utilization and complex treatment patterns of long-term regimens. This research investigates the treatment patterns of single and multiple inhaler long-term COPD regimens among Medicare beneficiaries.
METHODS: We identified COPD patients using 2017-2021 data from a 20% random sample of CMS fee for service (FFS) data. Patients were first grouped into six maintenance therapy regimens based on GOLD 2025 treatment guidelines (LAMA, LABA, LAMA+LABA, ICS, LABA+ICS, triple therapy) using the earliest 90-day episode of use following diagnosis. Combination therapy users were further classified as single (SIT) or multiple-inhaler users (MIT). Over a 12-month follow up period and within these six-long term regimens, we then implemented an algorithm to characterize utilization including discontinuations, continuations, lateral switches, step ups, and step downs.
RESULTS: Of the 172,964 identified COPD patients, 26,605 initiated long-term maintenance therapy. ICS+LABA SIT was the most utilized initial regimen (55%), followed by LAMA+LABA SIT (15%). Long-term follow-up data were available for 22,499 patients, with treatment events occurring on average at day 129 after initiation. Most patients either discontinued (47%) or continued (41%) their index regimen. Discontinuation was most common among ICS (50%) and ICS+LABA SIT users (51%), while continuation was highest among triple therapy SIT/MIT users (48%). Step ups were more frequently observed than step downs, and among patients who switched or stepped-up therapy, nearly half transitioned to triple therapy.
CONCLUSIONS: We characterized treatment changes among COPD patients across six regimens and distinguished between lateral switches, step ups, and step downs. While most patients started on ICS+LABA SIT, nearly half discontinued their long-term regimens, and among those with treatment changes, transitions disproportionately favored triple therapy.