Abstract Rationale Despite recent advances in therapeutics, undertreatment and disparities persist for patients with COPD. As of 2023, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report recommends inhaled triple therapy for patients with advanced COPD who exacerbate despite dual therapy. Care access varies by social factors, and investigation is needed to understand differences in triple therapy initiation. This study aimed to describe triple therapy initiation amongst patients with COPD experiencing exacerbations, as well as differences in initiation across clinical and social drivers of health. Methods This observational, retrospective analysis utilized 100% Medicare Fee-for-Service (FFS) and Inovalon MORE2 Registry of closed claims. Patients (age ≥40 years) were required to present ≥1 claim with COPD diagnosis between 1/1/2022 and 12/31/2022 (FFS) or 12/31/2023 (MORE2), ≥1 severe or ≥ 2 moderate COPD exacerbations (set as index date), and 12 months of continuous enrollment preceding and following the index date/triple therapy initiation. Single or multiple inhaler triple therapy initiation was identified within 12-months post-exacerbation. Demographics were assessed at index, while comorbid conditions and select COPD symptoms were identified within 12-months pre-index. Differences between initiators and non-initiators were assessed with chi-square tests of equality of proportions. Results Of 338,947 patients qualifying for analysis, 23,445 (6.9%) initiated triple therapy following one severe or two moderate COPD exacerbations. Statistically significant differences between triple therapy initiators and non-initiators were observed for age, gender, race/ethnicity, payer, and geographic groups (all p0.0001; Table 1). While 7.9% of patients ages 50-64 initiated triple therapy, only 5.2% of patients ages 80+ initiated. Commercial enrollees were most likely to initiate triple therapy (n = 2,986, 9.9%), while Medicare FFS enrollees were least likely (n = 10,327; 6.0%). Of those with known race, Black patients initiated least (6.7%), while Asian patients initiated most (7.7%). Notably, Asian women were less likely to initiate than Asian men (6.3% vs. 9.0%, p 0.001). Patients with COPD symptoms were more likely to initiate triple therapy than patients without symptoms, with higher frequency among those experiencing cough (8.8%), dyspnea (9.5%), sputum/mucus (10.7%), or wheezing (12.7%). Patients with pneumonia or tobacco dependence were more likely to initiate (10.0% and 8.4%) than patients without. Conclusions COPD symptoms, race, payer coverage, and age were identified as key factors related to triple therapy initiation. Nine out of ten patients with COPD exacerbations did not initiate triple therapy, suggesting suboptimal implementation of guideline-directed medical therapy for COPD management, and highlighting an opportunity for clinicians to engage in targeted counselling. This abstract is funded by: AstraZeneca
Chima-Melton et al. (Fri,) studied this question.