OBJECTIVES : Guidelines recommend triple therapy for asthma patients who remain uncontrolled on inhaled corticosteroid(ICS)/long-acting beta-agonists(LABA). A previous real-world study reported low adherence/persistence to multiple-inhaler triple therapy (MITT); however, single-inhaler FF/UMEC/VI has not been assessed. This study compared adherence and persistence among asthma patients receiving FF/UMEC/VI or MITT in a large US claims database.

METHODS : Retrospective cohort study conducted using US-based claims data on asthma patients initiating FF/UMEC/VI 100/62.5/25mcg or MITT between 09/18/2017-09/30/2019. Index date=first dispensing date for FF/UMEC/VI or first overlap in days supply of ICS, LABA, and long-acting muscarinic antagonist (LAMA). Subjects were ≥18 years old at index, continuously enrolled for ≥12 months pre-index (baseline) and ≥3 months post-index, and had ≥1 asthma diagnosis during baseline/index. Patients with baseline use of MITT or FF/UMEC/VI, or diagnosed with COPD, cystic fibrosis, or acute respiratory failure were excluded. Study endpoints: adherence measured by mean proportion of days covered (PDC), proportion achieving PDC≥0.8 and PDC≥0.5, and persistence (reported with Kaplan-Meier rates). Inverse probability of treatment weighting (IPTW) was used to control for confounding and post-weighting multivariable regression further adjusted for remaining differences in baseline characteristics.

RESULTS : In total 1,396 FF/UMEC/VI and 5,115 MITT initiators met study criteria. After IPTW, cohorts were balanced across most covariates. Among patients with ≥12 months follow-up, FF/UMEC/VI initiators (N=524) had significantly higher mean PDC over 12-months than MITT initiators (N=2,666) (mean[SD]: 0.46[0.33] vs 0.35[0.30],p<0.001). FF/UMEC/VI initiators had significantly higher adherence rates versus MITT initiators at 12 months (PDC≥0.80: 24.7% vs 12.9%; RR[95%CI]=2.01[1.61-2.60],p<0.001; PDC≥0.50: 38.3% vs 27.2%; RR[95%CI]=1.48[1.19-1.80],p<0.001). Additionally, FF/UMEC/VI initiators were more likely to persist on their treatment compared to MITT initiators at 6-months (40.5% vs 26.9%; HR[95%CI]=1.52[1.41-1.64], p<0.001) and 12-months (25.9% vs 15.1%; HR[95%CI]=1.49[1.39-1.60], p<0.001).

CONCLUSIONS : Asthma patients initiating triple therapy with single-inhaler FF/UMEC/VI had higher adherence and persistence compared to patients initiating multiple-inhaler triple therapy.

Funding: GSK-sponsored (Study HO-18-18555/208189)