Exacerbation Reduction in Patients With Asthma Following Initiation of Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) in the United States

Document Type

Conference Proceeding

Publication Date

5-20-2025

Publication Title

Am J Respir Crit Care Med

Abstract

Rationale: In the United States (US), up to 50% of patients with asthma remain uncontrolled despite adherence to inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) dual therapy, requiring escalation to triple therapy.Although the efficacy of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy has been demonstrated in clinical trials, real-world evidence on the clinical and economic benefits is sparse.This study evaluated the impact of FF/UMEC/VI on patients with asthma previously on ICS/LABA. Methods: This was a retrospective, longitudinal, pre-post claims study using Medicaid, commercial, and Medicare insurance data from the Komodo Health database. Data were collected from September 9, 2019, to December 31, 2023; the index date was the first pharmacy claim for FF/UMEC/VI. Eligible patients were adults with asthma with ≥12 months of continuous insurance coverage prior to and following the index date (pre- and post-initiation periods) who received ICS/LABA for ≥30 consecutive days during the pre-initiation period. Outcomes assessed included asthma-related exacerbations, oral corticosteroid (OCS) use, short-acting beta-agonist (SABA) use, asthma-related healthcare resource utilization (HRU, emergency department [ED] visits), and asthma-related medical costs. Odds/rate ratios (ORs/RRs; 95% confidence intervals [CIs]) of asthma-related exacerbations were compared pre-initiation versus post-initiation using logistic/Poisson regression models. OCS bursts, SABA canisters, and HRU were analyzed using Poisson regression models (RRs [95% CIs]); asthma-related medical costs were compared pre-initiation versus post-initiation using mean differences from generalized linear models. Results: Of 17,959 eligible patients, mean (standard deviation) age was 50.6 (14.1) and the majority were female (68.2%, n=12,240). Odds of any asthma-related exacerbations were significantly reduced by 52% post- versus pre-initiation (OR [95% CI]: 0.48 [0.46, 0.50], p<0.001); rates were reduced by 38% (RR [95% CI]: 0.62 [0.61, 0.64], p<0.001) (Figure). Rates of OCS bursts were 30% lower (RR [95% CI]: 0.70 [0.69, 0.72], p<0.001), SABA use 18% lower (RR [95% CI]: 0.82 [0.81, 0.83], p<0.001), asthma-related ED visits 39% lower (RR [95% CI]: 0.61 [0.58, 0.64], p<0.001) (Figure), and asthma-related medical costs 46% lower (mean difference [95% CI]: −$1115 [−$1771, −$459], p<0.001) post- versus pre-initiation. Conclusions: Significant reductions in asthma-related exacerbations, as well as lower OCS and SABA use, and reductions in asthma-related ED visits and medical costs were associated with the post-initiation period of FF/UMEC/VI treatment compared with the pre-initiation period. This provides novel, real-world evidence of the benefits of escalation to FF/UMEC/VI from ICS/LABA therapy in patients with asthma in the US, helping to inform treatment decisions in real-world clinical practice.

Volume

211

First Page

2

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