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Observational Study
. 2022 Mar 10;32(1):11.
doi: 10.1038/s41533-022-00270-2.

Characteristics and treatment patterns of patients with asthma on multiple-inhaler triple therapy in Spain

Miriam Barrecheguren  1   2 , Monica Monteagudo  3 , Marc Miravitlles  4   5 , Xavier Flor  6   7 , Alexa Núñez  4   7 , Jeisson Osorio  8 , Xavier Muñoz  4   5 , Iñigo Ojanguren  4   5   7
Affiliations
Observational Study

Characteristics and treatment patterns of patients with asthma on multiple-inhaler triple therapy in Spain

Miriam Barrecheguren et al. NPJ Prim Care Respir Med. .

Abstract

The aim of this observational, retrospective study was to describe characteristics, treatment patterns, and adherence among patients with asthma who initiated multiple-inhaler triple therapy (MITT) in Catalonia, Spain. This study used data of patients initiating MITT in 2016 from the SIDIAP (Information System for Research in Primary Care) database, which covers ~80% of the Catalonian population (5.8 million). Of 1,204 patients initiating MITT, 361 (30.0%) stepped down (discontinued ≥ 1 and continued ≥1 MITT component) and 89 (7.4%) stopped all three components of MITT for a period of 60 days during the following 12 months. In the follow-up period, 196 (16.3%) patients were considered adherent to MITT (>0.8 proportion of days covered [PDC]), with a mean (standard deviation) PDC of 0.52 (0.51) days. Given the low adherence and substantial rates of step down/discontinuation among patients initiating MITT, there is an urgent need to implement strategies to improve treatment adherence/persistence.

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Conflict of interest statement

I.O. has received travel grants, consulting fees, speaking fees or research grants from AstraZeneca, Bial, Boehringer Ingelheim, Chiesi, GSK, Mundipharma, Novartis, Teva, Sanofi, MSD and Puretech; I.O. is a researcher supported by the “Pla Estratègic de Recerca i Innovació en Salut PERIS)” 2016–2020 (SLT008/18/00108;G60594009). M.B. has received speaker fees from CSL Behring, Grifols, Menarini, GSK and Boehringer Ingelheim, consulting fees from GSK, Novartis and Boehringer Ingelheim. X.M. has received fees as a speaker, scientific advisor, or participant of clinical studies from AstraZeneca, Boehringer Ingelheim, Chiesi, Faes, GSK, Menarini, Mundipharma, Novartis, and Teva. M. Miravitlles has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Zambon, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Bial, Gebro Pharma, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, Teva, pH Pharma, Novartis and Grifols and research grants from Grifols. X.F. has received speaking fees from AstraZeneca, Chiesi, GSK, Mundipharma and Teva. M. Monteagudo, A.N., and J.O. declare no competing interests.

Figures

Fig. 1
Fig. 1. Study design.
ICS inhaled corticosteroid, LABA long-acting β2-agonist, LAMA long-acting muscarinic antagonist, MITT multiple-inhaler triple therapy.
Fig. 2
Fig. 2. Flow chart of the patient selection from the SIDIAP database.
COPD chronic obstructive pulmonary disease, LAMA long-acting muscarinic antagonist, MITT multiple-inhaler triple therapy, SIDIAP Information System for Research in Primary Care.
Fig. 3
Fig. 3. Treatment patterns 12 months prior to (pre-index) and 12 months following (post-index) MITT initiation in the overall population.
Percentages may not total 100% due to rounding. *ICS/LABA category includes: ICS/LABA, ICS/LABA/anti-leukotrienes, ICS/LABA/OCS, ICS/LABA/OCS/SAMA, ICS/LABA/anti-leukotrienes/OCS; †other category includes: ICS, ICS/LAMA, ICS/anti-leukotrienes, ICS/OCS, ICS/OCS/LAMA, LABA/LAMA, LABA/anti-leukotrienes, LAMA, LAMA/anti-leukotrienes, anti-leukotrienes, OCS, OCS/LAMA, OCS/LAMA/anti-leukotrienes. ICS inhaled corticosteroid, LABA long-acting β2-agonist, LAMA long-acting muscarinic antagonist, MITT multiple-inhaler triple therapy, OCS oral corticosteroid, SABA short-acting β2-agonist, SAMA short-acting muscarinic antagonist.
Fig. 4
Fig. 4. Treatment patterns in patients that persist, step-down and discontinue MITT.
a 12 months prior to (pre-index) and b 12 months following (post-index) MITT initiation. Percentages may not total 100% due to rounding. *ICS/LABA category includes: ICS/LABA, ICS/LABA/anti-leukotrienes, ICS/LABA/OCS, ICS/LABA/OCS/SAMA, ICS/LABA/anti-leukotrienes/OCS; †other category includes: ICS, ICS/LAMA, ICS/anti-leukotrienes, ICS/OCS, ICS/OCS/LAMA, LABA/LAMA, LABA/anti-leukotrienes, LAMA, LAMA/anti-leukotrienes, anti-leukotrienes, OCS, OCS/LAMA, OCS/LAMA/anti-leukotrienes. ICS inhaled corticosteroid, LABA long-acting β2-agonist, LAMA long-acting muscarinic antagonist, MITT multiple-inhaler triple therapy, OCS oral corticosteroid, SABA short-acting β2-agonist, SAMA short-acting muscarinic antagonist.
Fig. 5
Fig. 5. Treatment patterns in the 12 months prior to (pre-index) and 12 months following (post-index) MITT initiation among patients with severe exacerbations.
Percentages may not total 100% due to rounding. *ICS/LABA category includes: ICS/LABA, ICS/LABA/anti-leukotrienes, ICS/LABA/OCS, ICS/LABA/OCS/SAMA, ICS/LABA/anti-leukotrienes/OCS; †other category includes: ICS, ICS/LAMA, ICS/anti-leukotrienes, ICS/OCS, ICS/OCS/LAMA, LABA/LAMA, LABA/anti-leukotrienes, LAMA, LAMA/anti-leukotrienes, anti-leukotrienes, OCS, OCS/LAMA, OCS/LAMA/anti-leukotrienes. ICS inhaled corticosteroid, LABA long-acting β2-agonist, LAMA long-acting muscarinic antagonist, MITT multiple-inhaler triple therapy, OCS oral corticosteroid, SABA short-acting β2-agonist, SAMA short acting muscarinic antagonist.
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