Unmet Need, Substantial Disease Burden in Patients With Asthma Initiating Inhaler Therapy

The use of multiple-inhaler triple-therapy (MITT) in real-world patients with asthma is low but increasing marginally, according to results published online ahead of print in The Journal of Allergy and Clinical Immunology: In Practice. 

“In a clinical trial setting, the addition of a long-acting muscarinic antagonist (LAMA) to inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) maintenance therapy as part of a MITT regimen has been shown to improve lung function and reduce the risk of severe exacerbations among patients with asthma,” researchers wrote. “However, multiple-inhaler regimens introduce an added complexity to dosing, which may negatively impact patient adherence.” 

To gauge the prevalence of MITT in real-world settings, researchers analyzed claims data from a large population of adult patients with asthma. One or more overlapping days’ supply of ICS, LABA, and LAMA was considered evidence of MITT use. 

In 2014-2015, the prevalence of MITT among patients with asthma was 0.35%, according to the study. By 2017-1028, it had increased to 1.00%. 

Initially low MITT use may stem from the fact that LAMAs, although available for the treatment of chronic obstructive pulmonary disease, were not yet approved for the treatment of asthma and thus not included in treatment guidelines at the start of the study period, researchers wrote. In 2016, the Global Initiative for Asthma report recommended the LAMA tiotropium as a step 4 add-on treatment. 

When researchers looked at health care resource utilization (HCRU) among 1831 patients who initiated MITT, they found substantial disease burden and unmet needs. The population had high HCRU and exacerbation rates. Yet just 12% remained on MITT 12 months after initiation. 

“Adherence and persistence to MITT were low, but adherence to each individual triple therapy component was demonstrably higher, suggesting that patients were not using all three MITT components simultaneously,” researchers wrote. “Simplifying the inhaler regimen might improve adherence and persistence in patients with asthma who require triple therapy.” 

Reference: 

Oppenheimer J, Bogart M, Bengtson LGS, et al. Treatment patterns and disease burden associated with multiple-inhaler triple-therapy use in asthma [published online ahead of print, 2021 Oct 6]. J Allergy Clin Immunol Pract. 2021;S2213-2198(21)01060-6. doi:10.1016/j.jaip.2021.09.033