Better adherence with once- than twice-daily ICS/LABA therapy in asthma patients
medwireNews: Patients with asthma who are treated with the once-daily inhaled corticosteroid/long-acting beta agonist (ICS/LABA) regimen fluticasone furoate/vilanterol (FF/VI) have better treatment adherence than those taking the twice-daily budesonide/formoterol (BUD/F) combination, researchers report.
The real-world study of US claims data included 1725 patients initiating once-daily FF/VI in a dry-powder combination and the same number of propensity score-matched patients initiating twice-daily BUD/F in a metred dose inhaler. Patients were aged an average of approximately 52 years, and the majority (62.6–64.3%) were female.
Over an average follow-up of 255.7 days, adherence as measured by the mean proportion of days (PDC) covered by treatment – calculated by dividing the number of days with available medication by the duration of follow-up – was 0.43 for the patients taking the once-daily regimen.
This was significantly higher than the mean PDC in the twice-daily group, at 0.36, during an average 255.1 days of follow-up.
Moreover, patients taking once-daily treatment were significantly more likely than those in the twice-daily group to achieve a PDC of at least 0.5 and at least 0.8, with rates of 38.3% versus 26.6% and 17.5% versus 10.2%, respectively. After adjustment for baseline exacerbation rates, patients in the once-daily group were 72% more likely to achieve a PDC of 0.5 or more, and 86% more likely to achieve a PDC of at least 0.8, than those in the twice-daily group.
Richard Stanford (GlaxoSmithKline, Research Triangle Park, North Carolina, USA) and co-authors also found that patients taking the once- versus twice-daily regimen were a significant 26% less likely to discontinue treatment and had a significant 36% higher likelihood of achieving an asthma medication ratio (AMR; the ratio of controller medication to total asthma medication use) of at least 0.5.
These findings, together with previous studies showing that an AMR of at least 0.5 is associated with a reduction in the risk of asthma-related emergency department (ED) and inpatient (IP) hospital visits, suggest that “once-daily therapy could improve adherence and future asthma-related ED/IP event risk relative to a twice-daily alternative”, write the researchers in The Journal of Allergy and Clinical Immunology: In Practice.
The team concludes: “Future research could explore how patient preferences for treatment regimens and delivery devices are related to treatment adherence and outcomes as well as treatment effectiveness in certain sub-groups.”
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