A23-02 Treatment Patterns for Chronic Obstructive Pulmonary Disease (COPD) Maintenance Therapy Among Incident and Prevalent Patients in the United States (US): Findings From the DUALITY Patient Journey Study

Abstract Rationale Inhaled maintenance therapy (i.e., individual or combination therapy with long-acting beta agonists LABA, long-acting muscarinic antagonists LAMA, and inhaled corticosteroids ICS) is a mainstay of COPD treatment. This study provides a contemporary characterization of inhaled maintenance and other therapy use among patients across the COPD spectrum. Methods A retrospective study of COPD patients aged ≥40 years was conducted using US Komodo Research Data (KRD+) from 01/2016-06/2024. Incident patients had their first observed COPD diagnosis on or after 01/01/2022 (index: diagnosis date); prevalent patients had a COPD diagnosis before 2022 (index: 01/01/2022). Eligible patients had continuous health plan enrollment for 12 months pre-index (i.e., baseline) and ≥6 months post-index (unless they died). Treatment patterns were assessed during follow-up (index to death or end of enrollment/data availability). Up to 3 lines of inhaled maintenance therapy (LOT) were identified based on agents received within the first 30 days; changes were assessed by addition or discontinuation (≥90-day gap) of ≥ 1 agent. Results Among 1,421,278 patients, 153,390 (10.8%) were incident and 1,267,888 (89.2%) were prevalent (mean follow-up: 16.6 and 24.7 months). Incident patients were younger, less likely to be female or White, and had fewer comorbidities (Table 1). During follow-up, oral corticosteroids (43.6% and 53.7%) and antibiotics (67.1% and 75.6%) were common treatments; oxygen (13.6% and 17.5%) and non-invasive ventilation (3.3% and 4.0%) were less common. Inhaled maintenance therapy was received by 33.0% of incident and 51.2% of prevalent patients. Dual therapy was most common (20.2% and 32.5%), driven by ICS/LABA (14.3% and 25.3%), followed by triple therapy (12.5% and 22.5%), and monotherapy (7.6% and 12.0%). For patients initiating their first maintenance therapy (incident: n = 50,674; prevalent: n = 84,700), 18.6% had pulmonologists as their prescribing physicians; pulmonologists prescribed triple therapy more frequently (33.4% vs. 26.4% overall). Across LOTs, monotherapy use remained stable (∼20%) while triple therapy increased to ∼40% by the third LOT. Treatment discontinuation was the most common reason for change (∼30-50%). Conclusions In this large, real-world US study, only one-third of incident and half of prevalent COPD patients received inhaled maintenance therapy, and triple therapy use remained limited. The relatively common use of oral corticosteroids and antibiotics—indicators of COPD exacerbation—highlights potential suboptimal disease management and opportunity for intervention. Frequent treatment discontinuation suggests challenges with persistence, potentially reflecting barriers in access, affordability, or other unmet needs. These findings underscore the need for strategies to improve initiation, optimization, and persistence of COPD maintenance therapy. This abstract is funded by: AstraZeneca