Assessing adherence and persistence with asthma triple therapy
Published: June 22, 2022
To control asthma symptoms, asthma management guidelines emphasize the importance of adhering to medication and persisting with treatment. Adherence is the extent to which a patient takes their medication as prescribed, while persistence refers to the length of time that a patient takes their medication. Low adherence has been linked to poor asthma control, leading to an increased risk of asthma attacks and extra healthcare costs. For patients whose asthma is uncontrolled despite treatment with a combination of inhaled corticosteroids and long-acting beta-agonists (ICS/LABA), a ‘triple therapy’ combination of ICS/LABA plus a long-acting muscarinic antagonist (LAMA) is recommended. These medications act differently to relax airways and reduce airway inflammation, improving the control of asthma symptoms. Previously, this treatment combination was only available as multiple-inhaler triple therapy (MITT), requiring a mix of different inhaler devices and medication doses; however, a study showed that patients with asthma have low adherence and persistence with MITT when treated in real-world clinical practice. More recently, an ICS/LAMA/LABA triple therapy combination was approved as a once-daily single-inhaler triple therapy (SITT), which introduces a new treatment option for patients with poorly controlled asthma. However, there is limited information on adherence and persistence with SITT in patients with asthma.
This study by Busse et al, which was recently published in The Journal of Allergy and Clinical Immunology: In Practice, assessed whether adult patients with asthma were more likely to adhere to triple therapy medication and persist with treatment when it is SITT rather than MITT. From a total of 6511 adult patients, 1396 started using SITT (an ICS/LAMA/LABA triple therapy combination of fluticasone furoate, umeclidinium, and vilanterol [FF/UMEC/VI], taken from a single inhaler) once daily. MITT users (5115 patients) were patients who started taking a combination of any ICS, LAMA, and LABA from either two or three separate inhalers, with either once- or twice-daily dosing. Patients were followed for 12 months after SITT or MITT treatment started. Adherence was measured as the proportion of days covered (PDC), which is a measure used to estimate medication adherence by looking at the proportion of days in which a person has medication available and is assumed to have taken it, over a given period of time. Treatment persistence was assessed based on the time between patients starting and discontinuing treatment.
Three months after treatment started, patients receiving SITT showed significantly higher adherence with a mean PDC of 0.68, compared with MITT users who had a mean PDC of 0.59. SITT users were also 31% more likely to adhere to their treatment than patients receiving MITT at 3 months, while at 6 months this increased to 51%, and by 12 months they were twice as likely to adhere to therapy. In addition, patients receiving SITT were 49% more likely to persist with triple therapy at 12 months, compared with MITT. The authors concluded that once-daily FF/UMEC/VI in a single inhaler (SITT) was associated with better treatment adherence and persistence than triple therapy from multiple inhalers (MITT) in patients with asthma. Further research is needed to explore how improved adherence and persistence with SITT may have benefits in asthma control, and clinical and economic outcomes.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.