Real-World Treatment Patterns of Multiple-Inhaler Triple Therapy Among Patients with Chronic Obstructive Pulmonary Disease in UK General Practice

Figures & data

Table 1 Patient Characteristics and Disease Burden at Baseline

	Patients with COPD Initiating MITT (N=3825)
Age, years
Mean (SD)	69.5 (10.5)
Median	70.0
Male, n (%)	2045 (53.5)
Smoking status, n (%)^a
Former smoker	2109 (55.1)
Current smoker	1540 (40.3)
Never smoker	176 (4.6)
BMI, n (%)^a,b,c
Normal (18.5 to <25.0)	1240 (33.6)
Overweight (25.0 to <30.0)	1194 (32.4)
Obese (≥30.0)	1063 (28.8)
Moderate/severe dyspnea, n (%)^a,d,e	1948 (54.9)
Lung function, GOLD grade, n (%)^a,e
Mild (FEV1 ≥80% predicted)	187 (7.6)
Moderate (50%≤ FEV1 <80% predicted)	1270 (51.4)
Severe (30%≤ FEV1 <50% predicted)	877 (35.5)
Very severe (FEV1 <30% predicted)	138 (5.6)
AECOPD events, n (%)^a,f
0	1621 (42.4)
1	1077 (28.2)
≥2	1127 (29.5)
>1 Hospitalized event	488 (12.8)

Notes: ^aAll variables measured in the 12 months prior to initiation of MITT; ^bpercentages are based on non-missing values; ^cnot shown are underweight BMI category (5.0%), and missing BMI data (3.6%); ^dMRC score ≥3 (mMRC score ≥2); ^epercentages are based on non-missing values: 7.2% missing MRC score and 35.4% missing spirometry data; ^fdefined by any moderate or severe (hospitalized) acute exacerbation of COPD event.

Abbreviations: AECOPD, acute exacerbation of COPD; BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MITT, multiple-inhaler triple therapy; MRC, Medical Research Council; mMRC, modified Medical Research Council; SD, standard deviation.

Table 2 MITT Use and Persistence

	Patients with COPD Initiating MITT (N=3825)
Number of devices comprising MITT, n (%)
2	3302 (86.3)
3	523 (13.7)
Duration of continuous MITT use, n (%)
<1 month	535 (14.0)
≥1 to <2 months	978 (25.6)
≥2 to <3 months	439 (11.5)
≥3 to <6 months	513 (13.4)
≥6 to <12 months	450 (11.8)
12 months	910 (23.8)
Mean (SD), months	5.1 (4.6)
Median, months	2.86
	Patients with COPD Who Discontinued MITT (n=2661)
Prescribed therapy after MITT discontinuation, n (%)^a
ICS/LABA	1280 (48.1)
ICS/LAMA	70 (2.6)
LAMA/LABA	50 (1.9)
LABA	4 (0.2)
LAMA	1197 (45.0)
ICS	33 (1.2)
No further treatment	27 (1.0)

Notes: ^aOnly the first modification episode in the 12 months after MITT initiation was recorded; 253 (8.7%) patients, who reinitiated MITT after >30-day gap, are excluded from the denominator.

Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; MITT, multiple-inhaler triple therapy.

Figure 1 Treatment immediately preceding MITT initiation.

Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting muscarinic antagonist; MITT, multiple-inhaler triple therapy.

Table 3 Baseline Disease Burden by Persistence of MITT Use

	Persisted on MITT 12 Months	Persisted on MITT <12 Months	p-value
Total, n (%)	911 (23.8)	2914 (76.2)
Moderate/severe dyspnea^a,b,c	56%	55%	0.52
FEV1 <50% predicted^a,c	49%	39%	<0.001
AECOPD events^a,d
0	37.5%	43.9%	0.002
1	29.5%	27.7%
≥2	32.9%	28.4%
≥1 Hospitalized events	16%	12%	<0.001

Notes: ^aAll variables measured in the 12 months prior to initiation of MITT; ^bMRC score ≥3 (mMRC score ≥2); ^cpercentages are based on non-missing values: 7.2% missing MRC score and 35.4% missing spirometry data; ^ddefined by any moderate or severe (hospitalized) AECOPD event.

Abbreviations: AECOPD, acute exacerbation of COPD; FEV₁, forced expiratory volume in 1 second; MITT, multiple-inhaler triple therapy; MRC, Medical Research Council; mMRC, modified Medical Research Council.