Article Text
PDF
Abstract
Introduction and objectives A retrospective cohort analysis was conducted comparing persistence with, and adherence to, different inhaled corticosteroid/long-acting-β2-agonist (ICS/LABA) treatments by asthma patients. Here we report findings from patients initiating treatment with either FF/VI or BUD/FM, the latter administered either as flexible or fixed-dose.
Methods Patients in the UK with data registered in The Health Improvement Network (THIN) database, who had a first prescription (index date) for any ICS/LABA between 1 January 2013–17 January 2018 (study period) and a prior asthma diagnosis, were included if they had ≥12 months medical history prior to index date plus ≥1 post-index ICS/LABA prescription. Patients were excluded if aged <12 years or if there were records for either COPD diagnosis or previous non–study ICS/LABA treatment prior to index date. Study cohorts were matched by propensity score (1:up to 4; greedy method). Primary objective was to compare persistence of comparator ICS/LABAs up to 12 months post-index treatment (time to discontinuation* including switch). Secondary objectives were: proportion of days covered (PDC) and proportion of patients with ≥50% and ≥80% PDC at 12 months post-index; and rescue use (annualised number of short-acting bronchodilator prescriptions/patient) within 12 months after treatment initiation.
Results A total of 937 patients initiating FF/VI were matched to 3232 patients initiating BUD/FM. A higher proportion of patients persisted with FF/VI versus BUD/FM over 12 months (Kaplan-Meier analysis; figure 1). The likelihood of discontinuing treatment within 12 months after initiation was 35% lower for FF/VI than BUD/FM (index year-adjusted, hazard ratio=0.65; 95% CI 0.56–0.75; p<0.001). Mean (standard deviation) PDC was 77.7 (25.3) for FF/VI and 72.4 (26.1) for BUD/FM (p<0.0001), with median 88.2 versus 77.7 and significantly higher odds of achieving ≥50% and ≥80% PDC for FF/VI versus BUD/FM (779/936 [83.2%] vs 2447/3232 [75.7%]; odds ratio=1.35; 95% CI 1.09–1.67; p=0.006 and 544/936 [58.1%] vs 1562/3232 [48.3%]; odds ratio=1.28; 95% CI 1.08–1.52; p=0.004, respectively; per-protocol analyses). Annualised rescue use was numerically similar for FF/VI (4.7) versus BUD/FM (4.2).
Conclusion UK asthma patients initiating FF/VI were more likely to have higher persistence and better adherence to treatment than those initiating BUD/FM.
GlaxoSmithKline plc. -funded study (209967/HO-18–19688).
Primary objective: Treatment persistence with FF/VI vs BUD/FM – time to discontinuation* at 1 year