OBJECTIVES:

To investigate the clinical and economic impact of prompt versus delayed initiation of single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following an exacerbation of chronic obstructive pulmonary disease (COPD).

METHODS:

A retrospective cohort study of linked English primary and secondary care data. Patients aged ≥35 years, with a COPD diagnosis, smoking history, linkage to secondary care data and continuous GP registration for 12 months pre- and post-index were indexed on a moderate/severe COPD exacerbation with FF/UMEC/VI initiation within 180 days. The impact of prompt initiation of FF/UMEC/VI from the index exacerbation was examined for a minimum of 6 months. Hospital readmissions, and subsequent moderate/severe exacerbations and medical costs were compared following index and FF/UMEC/VI initiation, respectively. The associated impact of prompt initiation (per day) was estimated using regression models adjusted for potential confounders.

RESULTS:

1599 patients were included, of which, 393 (24.6%) initiated FF/UMEC/VI within 30 days of index exacerbation.

For each day of earlier initiation of FF/UMEC/VI, the rate of moderate/severe exacerbation and moderate exacerbations were lower; RR 0.9982 (95% CI 0.9969–0.9995; p=0.008) and RR 0.9974 (0.9959–0.9989; p=0.001) respectively. The rate of severe exacerbations was numerically lower (RR 0.9996, 0.9973–1.0018; p=0.70).

The odds of all-cause 30-day readmission were lower (RR 0.9940, 0.9886–0.9994; p=0.029), and COPD-related 30-day readmission was numerically lower (RR 0.9964, 0.9912–1.0017; p=0.186) per day of earlier initiation. Total COPD-related medical costs were 0.05% (RR 0.9995, 0.9992–0.9999; p=0.005) lower for each day of earlier initiation.

CONCLUSIONS:

Prompt initiation of FF/UMEC/VI following a COPD exacerbation was associated with fewer subsequent exacerbations and hospital readmissions and lower costs relative to delayed initiation. Benefits were seen with each day of earlier initiation, suggesting the optimal timing for initiation of FF/UMEC/VI may be shortly after index exacerbation.

Funding: GSK 217365