OBJECTIVES: To describe and compare medication adherence among patients with COPD in Germany, who initiated multiple inhaled triple therapy (MITT) or single inhaled triple therapy (SITT).

METHODS: Retrospective cohort study of patients with COPD who initiated MITT or SITT (fluticasone furoate/umeclidinium/vilanterol [FF/UMEC/VI] or formoterol/beclomethasone/glycopyrronium [FOR/BDP/GLY]) from Nov 2017–June 2019 in the WIG2 database. Patients were aged ≥35 years, continuously insured for ≥2 years and had no triple therapy prescriptions prior to index. Inverse probability of treatment weighting was used to balance cohorts. Adherence (proportion of days covered [PDC]≥80%) was assessed at 6, 12 and 18 months, and 4 different definitions were analyzed: 1a) only in patients with at least one follow-up prescription for the index triple therapy within 2 months of initiation; 1b) only during periods of continuous therapy; 2) allowing for stockpiling; and 3) allowing for stockpiling and for prescription coverage during hospitalization.

RESULTS: Of 5710 patients, 71% initiated MITT and 29% initiated SITT (12% FF/UMEC/VI; 17% FOR/BDP/GLY). Mean age was 66 years across all cohorts. MITT cohort had more patients with forced expiratory volume in 1 second [FEV₁]<50% and more comorbidities vs SITT cohort. Adherence was higher for SITTs vs MITT at all times and all analyses yielded consistent results. The highest proportion of adherent patients was observed with the 1b adherence definition at 6 months: 39% of patients on MITT; 57% of patients on FOR/BDP/GLY; and 64% of patients on FF/UMEC/VI.

CONCLUSIONS: This increase in adherence for SITT vs MITT was consistent for all analyses and over 18 months following treatment initiation, with FF/UMEC/VI showing the highest adherence at all times, and suggesting that a reduction of the number of inhalers required may improve adherence, irrespective of the definition used, and support GOLD guideline recommendations for use of SITT over MITT.