Adherence to LAMA/LABA therapies in middle-aged patients with chronic obstructive pulmonary disease: A group-based...

Longitudinal adherence patterns to LAMA/LABA therapy among middle-aged patients with COPD are not well understood. Because individuals aged 40-64 years typically self-manage medications with fewer age-related influences on adherence, this population allows clearer evaluation of temporal patterns. We therefore conducted a descriptive study among middle-aged patients to classify adherence trajectories and identify groups at risk of suboptimal adherence.

Using a Japanese claims database, we identified COPD patients aged 40-64 years who initiated glycopyrronium/indacaterol (GLY/IND), umeclidinium/vilanterol (UMEC/VI), or tiotropium/olodaterol (TIO/OLO). Group-based trajectory modeling was applied to the monthly proportion of days covered over 360 days to identify groups of patients with similar longitudinal adherence patterns.

The analysis included 240 GLY/IND initiators, 365 UMEC/VI initiators, and 496 TIO/OLO initiators. For GLY/IND initiators, three adherence groups were identified: consistently high (31.7%), gradually declining (17.1%), and immediately declining (51.3%). UMEC/VI initiators demonstrated four groups: consistently high (26.6%), gradually declining (9.9%), rapidly declining (19.7%), and immediately declining (43.8%). TIO/OLO initiators also showed three groups: consistently high (35.5%), gradually declining (20.0%), and immediately declining (44.6%). Across all cohorts, higher adherence groups more frequently had a greater comorbidity burden and fewer previous moderate exacerbations, whereas suboptimal adherence groups tended to be younger, included more women, and initiated LAMA/LABA therapy in clinical settings.

Middle-aged patients with COPD initiating LAMA/LABA therapy exhibited distinct adherence trajectories. Understanding these patterns may help inform more targeted approaches to support adherence and improve patient outcomes.