Assessment of adherence and asthma medication ratio (AMR) for a once-daily and twice-daily inhaled corticosteroid/long acting beta agonist (ICS/LABA) for asthma

Publication date: Available online 10 January 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Richard H. Stanford, Carlyne Averell, Emily D. Parker, Cori Blauer-Peterson, Tyler K. Reinsch, Ami R. Buikema

Abstract

Background

While efficacy and safety of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/F) have been demonstrated in clinical studies, real-world comparisons of utilization has not been performed.

Objective

Compare similar asthma patients initiating FF/VI or BUD/F on measures of adherence, persistence, and the asthma medication ratio (AMR).

Methods

This was a retrospective cohort study of commercial and Medicare Advantage with Part D enrollees initiating FF/VI or BUD/F for asthma. Adult patients (≥18 years), at least 15-months (12-months pre- and 3-months post-index) continuous enrollment, and ≥1 asthma diagnosis code were eligible for the study. Patients with a history of fixed-dose ICS/LABA and other respiratory disorders (COPD, cystic fibrosis, acute respiratory failure) in the baseline period were excluded. Propensity-score matching (PSM) was used to balance cohorts on baseline characteristics. Logistic regression and Cox-proportional hazard models were used to assess differences.

Results

Total of 9,951 patients met all criteria. After PSM, 1,725 patients were matched in each cohort. Subjects that initiated FF/VI had significantly higher mean proportion of days covered (PDC) (p<0.001), had 86% greater odds of PDC≥0.80 (adjusted OR: 1.86; 95% CI:1.51-2.30), 26% lower risk of discontinuation (adjusted HR: 0.74, 95% CI: 0.69-0.79), and 36% greater odds of an AMR ≥0.50 (adjusted OR: 1.36, 95% CI: 1.23-1.50) compared with BUD/F.

Conclusions

Adherence and treatment persistence were low in both cohorts, however, patients initiating once-daily FF/VI were more likely to be adherent, have an AMR ≥0.5, and were less likely to discontinue therapy compared with patients initiating twice-daily BUD/F. (GSK Study HO1617302/206482)

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