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Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study.
Int J Chron Obstruct Pulmon Dis 2019; 14:1721-1737IJ

Abstract

Background and objective

Retrospective claims data in patients with chronic obstructive pulmonary disease (COPD) initiating maintenance therapy with inhaled fixed-dose combinations of long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) versus inhaled corticosteroid (ICS)/LABA have not been reported.

Methods

Retrospective observational study in a COPD-diagnosed population of commercial and Medicare Advantage with Part D (MAPD) enrollees aged ≥40 years from a US health insurer database. Patients initiated umeclidinium/vilanterol (UMEC/VI [62.5/25 µg]) or fluticasone propionate/salmeterol (FP/SAL [250/50 µg]) between April 1, 2014 and August 31, 2016 (index date) and had 12 months continuous enrollment pre- and post-index. Exclusion criteria included an asthma diagnosis in the pre-index period/index date; ICS-, LABA-, or LAMA-containing therapy during the pre-index period; or pharmacy fills for both UMEC/VI and FP/SAL, multiple-inhaler triple therapy, a non-index therapy, or COPD exacerbation on the index date. Adherence (proportion of days covered [PDC] ≥80%) was modeled using weighted logistic regression following inverse probability of treatment weighting (IPTW). Weighted Kaplan-Meier and Cox proportional hazards regression following IPTW were performed for incidence of COPD exacerbation and escalation to multiple-inhaler triple therapy.

Results

The study population included 5306 patients (1386 initiating UMEC/VI and 3920 initiating FP/SAL). Adjusted odds of adherence were 2.00 times greater among UMEC/VI than FP/SAL initiators (95% confidence interval [CI]: 1.62─2.46; P<0.001). The adjusted hazard ratio (HR) for first exacerbation was 0.87 (95% CI: 0.74-1.01; P=0.067) among UMEC/VI versus FP/SAL initiators. UMEC/VI initiators had 35% lower adjusted risk of escalation to multiple-inhaler triple therapy (HR 0.65; 95% CI: 0.47-0.89; P=0.008) versus FP/SAL. On-treatment, UMEC/VI initiators had an adjusted 30% reduced risk of a first moderate/severe COPD exacerbation (HR 0.70; 95% CI: 0.54-0.90; P=0.006).

Conclusion

Patients with COPD initiating UMEC/VI had higher adherence and longer time before escalation to multiple-inhaler triple therapy than FP/SAL initiators.

Authors+Show Affiliations

US Value Evidence and Outcomes, GSK, Durham, NC, USA.Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA.Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA.Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA.Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA.Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA.US Value Evidence and Outcomes, GSK, Durham, NC, USA.US Value Evidence and Outcomes, GSK, Durham, NC, USA.US Medical Affairs, GSK, Durham, NC, USA.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31534326

Citation

Moretz, Chad, et al. "Real-world Effectiveness of Umeclidinium/vilanterol Versus Fluticasone Propionate/salmeterol as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease (COPD): a Retrospective Cohort Study." International Journal of Chronic Obstructive Pulmonary Disease, vol. 14, 2019, pp. 1721-1737.
Moretz C, Sharpsten L, Bengtson LG, et al. Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study. Int J Chron Obstruct Pulmon Dis. 2019;14:1721-1737.
Moretz, C., Sharpsten, L., Bengtson, L. G., Koep, E., Le, L., Tong, J., ... Ray, R. (2019). Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study. International Journal of Chronic Obstructive Pulmonary Disease, 14, pp. 1721-1737. doi:10.2147/COPD.S204649.
Moretz C, et al. Real-world Effectiveness of Umeclidinium/vilanterol Versus Fluticasone Propionate/salmeterol as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease (COPD): a Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis. 2019;14:1721-1737. PubMed PMID: 31534326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-world effectiveness of umeclidinium/vilanterol versus fluticasone propionate/salmeterol as initial maintenance therapy for chronic obstructive pulmonary disease (COPD): a retrospective cohort study. AU - Moretz,Chad, AU - Sharpsten,Lucie, AU - Bengtson,Lindsay Gs, AU - Koep,Eleena, AU - Le,Lisa, AU - Tong,Junliang, AU - Stanford,Richard H, AU - Hahn,Beth, AU - Ray,Riju, Y1 - 2019/08/01/ PY - 2019/02/09/received PY - 2019/07/10/accepted PY - 2019/9/20/entrez PY - 2019/9/20/pubmed PY - 2019/9/20/medline KW - COPD KW - ICS/LABA KW - LAMA/LABA KW - real-world effectiveness KW - retrospective cohort SP - 1721 EP - 1737 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 14 N2 - Background and objective: Retrospective claims data in patients with chronic obstructive pulmonary disease (COPD) initiating maintenance therapy with inhaled fixed-dose combinations of long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) versus inhaled corticosteroid (ICS)/LABA have not been reported. Methods: Retrospective observational study in a COPD-diagnosed population of commercial and Medicare Advantage with Part D (MAPD) enrollees aged ≥40 years from a US health insurer database. Patients initiated umeclidinium/vilanterol (UMEC/VI [62.5/25 µg]) or fluticasone propionate/salmeterol (FP/SAL [250/50 µg]) between April 1, 2014 and August 31, 2016 (index date) and had 12 months continuous enrollment pre- and post-index. Exclusion criteria included an asthma diagnosis in the pre-index period/index date; ICS-, LABA-, or LAMA-containing therapy during the pre-index period; or pharmacy fills for both UMEC/VI and FP/SAL, multiple-inhaler triple therapy, a non-index therapy, or COPD exacerbation on the index date. Adherence (proportion of days covered [PDC] ≥80%) was modeled using weighted logistic regression following inverse probability of treatment weighting (IPTW). Weighted Kaplan-Meier and Cox proportional hazards regression following IPTW were performed for incidence of COPD exacerbation and escalation to multiple-inhaler triple therapy. Results: The study population included 5306 patients (1386 initiating UMEC/VI and 3920 initiating FP/SAL). Adjusted odds of adherence were 2.00 times greater among UMEC/VI than FP/SAL initiators (95% confidence interval [CI]: 1.62─2.46; P<0.001). The adjusted hazard ratio (HR) for first exacerbation was 0.87 (95% CI: 0.74-1.01; P=0.067) among UMEC/VI versus FP/SAL initiators. UMEC/VI initiators had 35% lower adjusted risk of escalation to multiple-inhaler triple therapy (HR 0.65; 95% CI: 0.47-0.89; P=0.008) versus FP/SAL. On-treatment, UMEC/VI initiators had an adjusted 30% reduced risk of a first moderate/severe COPD exacerbation (HR 0.70; 95% CI: 0.54-0.90; P=0.006). Conclusion: Patients with COPD initiating UMEC/VI had higher adherence and longer time before escalation to multiple-inhaler triple therapy than FP/SAL initiators. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/31534326/Real-world_effectiveness_of_umeclidinium/vilanterol_versus_fluticasone_propionate/salmeterol_as_initial_maintenance_therapy_for_chronic_obstructive_pulmonary_disease_(COPD):_a_retrospective_cohort_study L2 - https://dx.doi.org/10.2147/COPD.S204649 DB - PRIME DP - Unbound Medicine ER -