Contemporary Inhaled Maintenance Therapy Patterns and Treatment Progression for Chronic Obstructive Pulmonary Disease (COPD) in the United States: Findings from the DUALITY Patient Journey Study

Inhaled maintenance therapy (long-acting β 2 -agonists [LABA], long-acting muscarinic antagonists [LAMA], and inhaled corticosteroids [ICS], used alone or in combination) is the cornerstone of chronic obstructive pulmonary disease (COPD) management. This study described contemporary real-world COPD treatment patterns in the USA. Retrospective data for patients aged ≥ 40 years with COPD were obtained from Komodo Research Data (01/01/2016–06/30/2024). The index date was January 1, 2022 for patients with a prior COPD diagnosis (i.e., prevalent patients) or the first observed COPD diagnosis for incident patients. Continuous health insurance enrollment was required for ≥ 12 months pre-index (i.e., baseline) and ≥ 6 months post-index, unless death occurred (i.e., follow-up). A claims-based algorithm identified lines of therapy for inhaled maintenance treatments. Treatment patterns were described during follow-up, overall and among subgroups of interest, including at-risk patients (i.e., ≥ 1 severe or ≥ 2 moderate exacerbations during baseline). A total of 1,421,278 patients with COPD were identified (incident 153,390; prevalent 1,267,888). Over a mean follow-up of 16.6 and 24.7 months, 33.0% and 51.2% of patients with incident or prevalent COPD, respectively, received inhaled maintenance therapy. Dual therapy was the most common treatment class (20.2%, 32.5%), driven by ICS/LABA use, followed by triple therapy (12.5%, 22.5%), and monotherapy (7.6%, 12.0%). Among at-risk patients, only 58.8% received any inhaled maintenance therapy (dual therapy 37.0%, triple therapy 27.8%, monotherapy 13.2%). In this real-world study, there was unmet need across the COPD journey, evidenced by low uptake of inhaled maintenance therapy, including among those with a history of exacerbations. Maintenance therapy regimens were not fully aligned with Global Initiative for Chronic Obstructive Lung Diseases recommended treatment, and persistence to triple therapy was limited. Further research is warranted to understand barriers to timely treatment initiation, optimize escalation and persistence, and identify patients with unmet need despite inhaled maintenance therapy.