Treatment patterns in English asthma patients initiating multiple inhaler triple therapy: a cohort study

Background: The GINA recommendation to consider LAMA as add-on to ICS-LABA is recent and follows the 2014 asthma indication approval for tiotropium in the EU. Data on real world use of LAMA plus ICS-LABA in England is limited. Aim: Describe prescribing of multiple inhaler triple therapy (MITT, ICS-LABA+LAMA) for asthma in 1yr after initiation (discontinuation, step-down therapy, repeat MITT use, adherence). Methods: Retrospective cohort study using CPRD-Aurum primary care data. Index date was MITT initiation (Jan’10-Nov’17) defined as ≥1day overlap of ICS-LABA and LAMA prescriptions. Patients needed ≥1 asthma diagnosis, 1yr data prep B- patients adding ICS-LABA to LAMA. Results: 9375 MITT initiators identified; 70% stepped up from ICS-LABA. Characteristics and treatment patterns are in the Table. Conclusion: A third of patients step up to MITT via a non-recommended treatment sequence. Regardless of route to MITT, most patients discontinued MITT (gap >30days) within 1yr - many reverted to pre-MITT treatment, stopped ICS-LABA or stopped ICS-LABA+LAMA together. Over half received MITT again, suggesting patients see a benefit of MITT, even with inconsistent use. Method: GSK PRJ2753