Effectiveness of Switching from Multiple-Inhaler to Once-Daily Single-Inhaler Triple Therapy in Patients with COPD in a Real-World Setting in Japan
Bibliographic record
Abstract
Purpose: Following the relatively recent introduction of single-inhaler triple therapies in Japan, this study compared the effectiveness of switching from multiple-inhaler triple therapy (MITT) to once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) by investigating COPD exacerbations and adherence among patients with chronic obstructive pulmonary disease (COPD) in Japan. Methods: This retrospective, pre–post cohort study using the Medical Data Vision Co. Ltd database identified patients with ≥ 1 inpatient diagnosis and/or ≥ 2 outpatient diagnoses of COPD at age ≥ 40 years prior to the index date (first/earliest date of single-inhaler FF/UMEC/VI initiation from May 1, 2019–February 28, 2022, following a switch from MITT). The proportion of patients with ≥ 1 overall (moderate-to-severe), moderate, or severe COPD exacerbation and rate of exacerbations were assessed at 6 months pre- and post-index. Medication adherence (proportion of days covered [PDC]) was also assessed. Results: In total, 2365 patients were included, with a mean (standard deviation) age of 75.3 (9.7) years, and 77.1% were male. In the 6 months post-switch from MITT to FF/UMEC/VI, there was a statistically significant decrease in the proportion of patients who experienced ≥ 1 overall (11.2% to 8.8%; p =0.0014) and severe exacerbation (4.6% to 3.2%; p =0.0069). There was a similar proportion of patients who experienced ≥ 1 moderate exacerbation pre- and post-switch (6.9% to 6.2%; p =0.2394). Rates of overall (rate ratio [RR]: 0.86, 95% confidence interval [CI]: 0.74– 1.00; p =0.0528) and moderate exacerbations (RR: 0.95, 95% CI: 0.79– 1.13; p =0.5796) were numerically lower post-switch. There was a significant reduction in severe exacerbations post-switch (RR: 0.68, 95% CI: 0.51– 0.90; p =0.0084). Mean PDC was significantly higher in the 6 months post- versus pre-switch (0.83 versus 0.80; p < 0.0001). Conclusion: Patients who switched from MITT to FF/UMEC/VI had reduced exacerbations and improved adherence. These results may help inform healthcare providers on the optimum management strategy for patients with COPD in Japan. Plain Language Summary: Current guidelines recommend that patients with chronic obstructive pulmonary disease (COPD) who experience exacerbations (flare-ups of their symptoms) should be treated with a combination of three treatments, known as triple therapy. Patients can receive multiple-inhaler triple therapy (MITT) or single-inhaler triple therapy (SITT). SITT offers an easier and more convenient treatment plan than MITT and has been shown to improve adherence (the extent to which patients use their treatments as recommended/prescribed). Two SITTs have been approved for use in Japan, including once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI). Following the relatively recent introduction of SITTs in Japan, this study compared the effectiveness of switching from MITT to FF/UMEC/VI by investigating COPD exacerbations and adherence among patients with COPD in Japan. Patients included in this study were identified from the Medical Data Vision Co. Ltd database, who had switched from using MITT to using FF/UMEC/VI. We assessed COPD exacerbations and adherence to treatment in the 6 months before patients switched from MITT to FF/UMEC/VI and the 6 months following the switch. We found that patients who switched from MITT to FF/UMEC/VI had lower rates of exacerbations in the 6 months after the switch compared with the 6 months before the switch. Patients also had improved treatment adherence in the 6 months post-switch compared with the 6 months pre-switch. The findings of this study may help healthcare providers to prescribe the best treatment plan for patients with COPD in Japan, to help improve their treatment outcomes. Keywords: adherence, chronic obstructive pulmonary disease exacerbations, claims database, fluticasone furoate/umeclidinium/vilanterol, multiple-inhaler triple therapy
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".