TY - JOUR
T1 - Initial maintenance therapy adherence among older adults with asthma-COPD overlap
AU - Nili, Mona
AU - Lemasters, Traci J.
AU - Adelman, Megan
AU - Dwibedi, Nilanjana
AU - Madhavan, S. Suresh
AU - Sambamoorthi, Usha
N1 - Funding Information:
Author Affiliations: Department of Pharmaceutical Systems and Policy (MN, TJL, ND, US) and Department of Clinical Pharmacy (MA), West Virginia University School of Pharmacy, Morgantown, WV; System College of Pharmacy, University of North Texas (SSM), Fort Worth, TX. Source of Funding: None. Author Disclosures: Dr Sambamoorthi’s work was partially supported by grant NIMHD-5U54MD006882-10. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. Authorship Information: Concept and design (MN, TJL, ND, SSM, US); acquisition of data (US); analysis and interpretation of data (MN, MA, US); drafting of
Publisher Copyright:
© 2021 Ascend Media. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - OBJECTIVES: To examine the impact of initial maintenance therapy (IMT) type (inhaled corticosteroid [ICS] vs fixed-dose combination of ICS and long-acting β agonist [ICS/LABA]) on trajectories of adherence among older adults (≥65 years) with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO). STUDY DESIGN: We used a longitudinal, retrospective cohort design. METHODS: This study used a cohort of older adults with ACO using longitudinal data from a 10% sample of Optum’s Deidentified Clinformatics Data Mart. We adopted group-based trajectory modeling to identify medication adherence trajectories over 12 months. Multinomial logistic regressions were used to evaluate the unadjusted and adjusted associations of IMT medication and adherence trajectory categories. All analyses accounted for treatment option selection bias with inverse probability treatment weighting. RESULTS: Of 1555 individuals, 73% of the sample used ICS/LABA for IMT. Four medication adherence trajectories were observed regardless of regimen: (1) persistent high adherence (12.0%), (2) progression to high adherence (20.8%), (3) progression to low adherence (10.5%), and (4) persistent low adherence (56.7%). Those who were initiated on ICS/LABA were less likely to have persistent low adherence (unadjusted odds ratio [OR], 0.44; 95% CI, 0.29-0.67) compared with those initiated on ICS monotherapy when “persistent high adherence” was used as the reference group. The relationship remained significant in adjusted regressions (adjusted OR, 0.38; 95% CI, 0.24-0.59). CONCLUSIONS: Real-world evidence suggests that using ICS/LABA for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy.
AB - OBJECTIVES: To examine the impact of initial maintenance therapy (IMT) type (inhaled corticosteroid [ICS] vs fixed-dose combination of ICS and long-acting β agonist [ICS/LABA]) on trajectories of adherence among older adults (≥65 years) with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO). STUDY DESIGN: We used a longitudinal, retrospective cohort design. METHODS: This study used a cohort of older adults with ACO using longitudinal data from a 10% sample of Optum’s Deidentified Clinformatics Data Mart. We adopted group-based trajectory modeling to identify medication adherence trajectories over 12 months. Multinomial logistic regressions were used to evaluate the unadjusted and adjusted associations of IMT medication and adherence trajectory categories. All analyses accounted for treatment option selection bias with inverse probability treatment weighting. RESULTS: Of 1555 individuals, 73% of the sample used ICS/LABA for IMT. Four medication adherence trajectories were observed regardless of regimen: (1) persistent high adherence (12.0%), (2) progression to high adherence (20.8%), (3) progression to low adherence (10.5%), and (4) persistent low adherence (56.7%). Those who were initiated on ICS/LABA were less likely to have persistent low adherence (unadjusted odds ratio [OR], 0.44; 95% CI, 0.29-0.67) compared with those initiated on ICS monotherapy when “persistent high adherence” was used as the reference group. The relationship remained significant in adjusted regressions (adjusted OR, 0.38; 95% CI, 0.24-0.59). CONCLUSIONS: Real-world evidence suggests that using ICS/LABA for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy.
UR - http://www.scopus.com/inward/record.url?scp=85119591474&partnerID=8YFLogxK
U2 - 10.37765/ajmc.2021.88773
DO - 10.37765/ajmc.2021.88773
M3 - Article
AN - SCOPUS:85119591474
SN - 1088-0224
VL - 27
SP - 463
EP - 470
JO - American Journal of Managed Care
JF - American Journal of Managed Care
IS - 11
ER -