Benefit of prompt initiation of single-inhaler fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) in patients with COPD in England following an exacerbation: a retrospective cohort study

Respiratory Research

Research

David M. G. Halpin¹  Chris Compton²  Raj Sharma²  Robert P. Wood³  Olivia Massey³  Lucinda J. Camidge³  Victoria L. Banks⁴  Shannon N. Millard⁵  Afisi S. Ismaila⁶  Kieran J. Rothnie⁷  Alexandrosz Czira⁷ 

[1] College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK;Global Medical, GSK, London, UK;Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK;Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK;Integrated Evidence Generation (Women’s Health Care), Bayer PLC, Reading, UK;Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK;P1vital Limited, Wallingford, Oxfordshire, UK;Value Evidence and Outcomes, R&D Global Medical, GSK, 1250 South Collegeville Road, Collegeville, PA, USA;Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada;Value Evidence and Outcomes, R&D Global Medical, GSK, London, UK;

关键词: Chronic obstructive pulmonary disease;    Exacerbation;    FF/UMEC/VI;    Healthcare cost;    SITT;   

DOI  :  10.1186/s12931-023-02523-1

 received in 2022-12-19, accepted in 2023-08-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTriple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite dual therapy. The optimal timing of triple therapy following an exacerbation of COPD is unknown. The outcomes of prompt (≤ 30 days) vs. delayed (31–180 days) initiation of single-inhaler triple therapy with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) following an exacerbation of COPD were examined.MethodsThis was a retrospective cohort study of linked English primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Patients aged ≥ 35 years with COPD were indexed on the first and/or earliest date of exacerbation between November 15, 2017 and March 31, 2019 with subsequent FF/UMEC/VI initiation within 180 days. Patients were required to be continuously registered with a general practitioner for ≥ 12 months prior to and following index. Subsequent exacerbations, direct medical costs, and hospital readmissions were compared between prompt and delayed initiators. Inverse probability of treatment weighting was used to adjust for measured confounders between cohorts.ResultsOverall, 1599 patients were included (prompt: 393, delayed: 1206). After weighting, prompt initiators had numerically lower moderate/severe exacerbations compared with delayed initiators (rate ratio: 0.87, 95% confidence interval [CI]: 0.76–1.01, p = 0.0587). Both all-cause and COPD-related 30-day hospital readmissions were significantly lower among patients with prompt initiation compared with delayed initiators (all-cause: 23.6% vs. 34.6%, odds ratio [95% CI]: 0.58 [0.36–0.95], p = 0.0293; COPD-related: 20.3% vs. 30.6%, odds ratio [95% CI]: 0.58 [0.35–0.96], p = 0.0347). Prompt initiators also had numerically lower all-cause total costs and significantly lower COPD-related costs per-person-per year compared with delayed initiators (COPD-related: £742 vs. £801, p = 0.0016).ConclusionPrompt initiation of FF/UMEC/VI following a moderate/severe exacerbation was associated with fewer subsequent exacerbations, fewer hospital readmissions, and lower COPD-related medical costs compared with delayed initiation.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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