Initial maintenance therapy adherence among older adults with asthma-COPD overlap

Area of Science:

• Respiratory Medicine
• Pharmacoeconomics
• Geriatric Medicine

Background:

• Asthma-COPD overlap (ACO) presents unique challenges in older adults (≥65 years).
• Medication adherence is crucial for managing ACO but can be complex in this demographic.
• Understanding the impact of initial maintenance therapy (IMT) on adherence is vital for optimizing patient outcomes.

Purpose of the Study:

• To investigate how different types of initial maintenance therapy (IMT) affect medication adherence trajectories in older adults with ACO.
• To compare the adherence patterns between inhaled corticosteroid (ICS) monotherapy and fixed-dose combination of ICS and long-acting beta-agonist (ICS/LABA).

Main Methods:

• A longitudinal, retrospective cohort study using a 10% sample from Optum's Deidentified Clinformatics Data Mart.
• Group-based trajectory modeling identified medication adherence patterns over 12 months.
• Multinomial logistic regressions and inverse probability treatment weighting analyzed the association between IMT type and adherence trajectories.

Main Results:

• Out of 1555 individuals, 73% received ICS/LABA for IMT.
• Four adherence trajectories were identified: persistent high, progression to high, progression to low, and persistent low adherence.
• Initiation with ICS/LABA was associated with a significantly lower likelihood of persistent low adherence compared to ICS monotherapy (adjusted OR, 0.38).

Conclusions:

• Real-world data suggest that ICS/LABA as initial maintenance therapy may improve medication adherence over time in older adults with ACO.
• This finding supports the use of ICS/LABA combinations for enhancing adherence in this patient population.
• Further research could explore long-term outcomes associated with different adherence trajectories.