Chronic obstructive pulmonary diseases (Miami, Fla.) · 2026
Trends in the Use of Triple Therapy in Patients With COPD in the United States, 2019 to 2022.
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Bhatt Surya P, Clark Brendan, DuCharme Mary, Veeranki Phani, Barnes Timothy L
Аннотация
RATIONALE: Inhaled triple therapy (TT) combining a long-acting beta2-agonist, long-acting muscarinic antagonist, and inhaled corticosteroid is recommended for chronic obstructive pulmonary disease (COPD) patients with frequent exacerbations. Despite guideline criteria, TT is often initiated in patients unlikely to benefit.
OBJECTIVES: We aimed to characterize trends in the use of TT among COPD patients and concordance with guideline recommendations.
METHODS: This observational study used de-identified commercial and Medicare Advantage Part D claims from the Optum Research Database (2018–2022). Patients ≥40 years old with COPD who initiated TT between 2019 and 2022 were included. Baseline characteristics, prior respiratory medication use, and exacerbation history during the 12-month period before TT initiation (index date) were summarized overall and stratified by calendar year and TT type (single-inhaler TT [SITT] versus multiple-inhaler TT [MITT]). A subgroup analysis evaluated maintenance-naive initiators, defined as no maintenance inhaler use in the prior 12 months.
RESULTS: A total of 60,169 patients initiating TT were included. The proportion using SITT increased steadily from 53.0% in 2019 to 79.3% in 2022. Most patients (61.9%) had a low exacerbation history consistent with the Global initiative for chronic Lung Disease (GOLD) group A/B, increasing from 53.0% to 66.0% over the study period. Approximately 40% had zero exacerbations in the previous 12 months. One third of initiators were maintenance naive. SITT use was associated with significantly higher odds of guideline-discordant initiation relative to MITT (adjusted odds ratio 5.04; 95% confidence interval: 4.76–5.33).
CONCLUSION: TT initiation discordant with GOLD recommendations has increased in the United States, coinciding with an increase in the use of SITT over the corresponding period.
OBJECTIVES: We aimed to characterize trends in the use of TT among COPD patients and concordance with guideline recommendations.
METHODS: This observational study used de-identified commercial and Medicare Advantage Part D claims from the Optum Research Database (2018–2022). Patients ≥40 years old with COPD who initiated TT between 2019 and 2022 were included. Baseline characteristics, prior respiratory medication use, and exacerbation history during the 12-month period before TT initiation (index date) were summarized overall and stratified by calendar year and TT type (single-inhaler TT [SITT] versus multiple-inhaler TT [MITT]). A subgroup analysis evaluated maintenance-naive initiators, defined as no maintenance inhaler use in the prior 12 months.
RESULTS: A total of 60,169 patients initiating TT were included. The proportion using SITT increased steadily from 53.0% in 2019 to 79.3% in 2022. Most patients (61.9%) had a low exacerbation history consistent with the Global initiative for chronic Lung Disease (GOLD) group A/B, increasing from 53.0% to 66.0% over the study period. Approximately 40% had zero exacerbations in the previous 12 months. One third of initiators were maintenance naive. SITT use was associated with significantly higher odds of guideline-discordant initiation relative to MITT (adjusted odds ratio 5.04; 95% confidence interval: 4.76–5.33).
CONCLUSION: TT initiation discordant with GOLD recommendations has increased in the United States, coinciding with an increase in the use of SITT over the corresponding period.