Adherence to LAMA/LABA therapies in middle-aged patients with chronic obstructive pulmonary disease: A group-based trajectory analysis.

BACKGROUND

Longitudinal adherence patterns to LAMA/LABA therapy among middle-aged patients with COPD are not well understood. Because individuals aged 40-64 years typically self-manage medications with fewer age-related influences on adherence, this population allows clearer evaluation of temporal patterns. We therefore conducted a descriptive study among middle-aged patients to classify adherence trajectories and identify groups at risk of suboptimal adherence.

METHODS

Using a Japanese claims database, we identified COPD patients aged 40-64 years who initiated glycopyrronium/indacaterol (GLY/IND), umeclidinium/vilanterol (UMEC/VI), or tiotropium/olodaterol (TIO/OLO). Group-based trajectory modeling was applied to the monthly proportion of days covered over 360 days to identify groups of patients with similar longitudinal adherence patterns.

RESULTS

The analysis included 240 GLY/IND initiators, 365 UMEC/VI initiators, and 496 TIO/OLO initiators. For GLY/IND initiators, three adherence groups were identified: consistently high (31.7%), gradually declining (17.1%), and immediately declining (51.3%). UMEC/VI initiators demonstrated four groups: consistently high (26.6%), gradually declining (9.9%), rapidly declining (19.7%), and immediately declining (43.8%). TIO/OLO initiators also showed three groups: consistently high (35.5%), gradually declining (20.0%), and immediately declining (44.6%). Across all cohorts, higher adherence groups more frequently had a greater comorbidity burden and fewer previous moderate exacerbations, whereas suboptimal adherence groups tended to be younger, included more women, and initiated LAMA/LABA therapy in clinical settings.

CONCLUSIONS

Middle-aged patients with COPD initiating LAMA/LABA therapy exhibited distinct adherence trajectories. Understanding these patterns may help inform more targeted approaches to support adherence and improve patient outcomes.