Benefit of prompt initiation of single-inhaler triple therapy in COPD patients in England following an exacerbation

Abstract

<b>Introduction:</b> The optimal timing of initiation of single-inhaler triple therapy for COPD is unclear. The impact of prompt vs delayed initiation of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following a COPD exacerbation was investigated. <b>Methods:</b> This was a retrospective cohort study of linked UK primary and secondary care data. Patients aged ≥35 years, with a COPD diagnosis and smoking history were indexed on a COPD exacerbation with FF/UMEC/VI initiation within 180 days. Subsequent exacerbations, medical costs, and hospital readmissions were compared between prompt (≤14 and ≤30 days) and delayed (&gt;14 and &gt;30 days) initiators of FF/UMEC/VI following index. Baseline characteristics were balanced using inverse probability of treatment weighting. <b>Results:</b> 1599 patients were included (prompt ≤14 days: 223; prompt ≤30 days: 393). After weighting, prompt initiators (≤14 days) had significantly lower exacerbations (Rate Ratio 0.81, 95% CI [0.68–0.96]) and prompt initiators (≤30 days) had numerically lower exacerbations (0.87, [0.76–1.01]) compared with delayed initiators. Prompt initiators (≤30 days) had lower hospital readmissions (Table 1) and COPD-related medical costs (mean £742 vs £801; p=0.0016). <b>Conclusions:</b> Prompt initiation of FF/UMEC/VI following a COPD exacerbation was associated with lower exacerbations, hospital readmissions and costs relative to delayed initiation. <b>Funding:</b> GSK 217365