Adherence to single-inhaler triple therapies in middle-aged patients with chronic obstructive pulmonary disease: A group-based trajectory analysis.

BACKGROUND: Middle-aged patients with chronic obstructive pulmonary disease (COPD) initiating single-inhaler triple therapy (SITT) exhibit heterogeneous adherence trajectories. To clarify differences in the timing of adherence decline and identify patients at risk of poor adherence, we conducted a descriptive study to classify these patterns.

METHODS: We identified COPD patients aged 40 to 64 years who initiated fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) or budesonide/glycopyrronium/formoterol (BUD/GLY/FOR) using a Japanese claims database. Group-based trajectory modeling was used to analyze the monthly proportion of days covered over time, with groups classified by similar 360-day adherence trajectories.

RESULTS: 1075 patients were included in the analysis for FF/UMEC/VI and 638 patients for BUD/GLY/FOR. Five adherence groups were identified among patients initiating FF/UMEC/VI: (1) a consistently high group (25.2%), (2) a gradually declining group (12.2%), (3) a rapidly declining adherence group (12.3%), (4) an early-decline/partial-recovery group (6.4%), and (5) an immediately declining group (43.9%). Similarly, five adherence groups were also seen among BUD/GLY/FOR initiators: (1) a consistently high group (17.1%), (2) a gradually declining group (5.0%), (3) a rapidly declining group (12.7%), (4) a moderately stable group (12.9%), and (5) an immediately declining group (52.4%). In both cohorts, higher adherence groups tended to be older and have more comorbidities, while suboptimal adherence groups were more often female, had fewer prior treatments, and began SITT in clinics.

CONCLUSIONS: We identified distinct adherence patterns among middle-aged COPD patients initiating treatment with FF/UMEC/VI or BUD/GLY/FOR. Understanding the characteristics of these patterns may enable more targeted interventions to improve adherence and patient outcomes.