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 - 2020/3/19/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 -