Abstract
INTRODUCTION: Assessment of blood eosinophil count (BEC) is recommended to guide the use of inhaled corticosteroids in chronic obstructive pulmonary disease (COPD), with BEC ≥300 cells/μL predictive of patients most likely to benefit. OBJECTIVE: To compare outcomes between patients initiating dual bronchodilator therapy with tiotropium/olodaterol (TIO/OLO) versus triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) in patients with COPD and BEC ≤300 cells/μL. METHODS: A retrospective cohort study using claims data from the Optum Research Database. Patients with COPD initiated on TIO/OLO or FF/UMEC/VI between 01 June 2015 and 30 November 2019, with a baseline BEC were included. TIO/OLO initiators were 1:1 propensity score matched with FF/UMEC/VI initiators. Time to first exacerbation and pneumonia diagnosis were assessed using Kaplan-Meier analysis. COPD exacerbations and COPD and/or pneumonia-related healthcare resource utilization (HRU) and cost outcomes were presented as population annualized averages. RESULTS: The study population included 3867 individuals with a baseline BEC result. Among these, 3168 (81.9%) had BEC ≤300 cells/μL. After matching, 1098 matched pairs with BEC ≤300 cells/μL were retained. The follow-up annualized count of moderate/severe exacerbations was not significantly different between TIO/OLO and FF/UMEC/VI initiators (1.05 vs 0.99, p=0.535). Annualized counts of COPD and/or pneumonia-related HRU were not significantly different, except for emergency department visits, which were lower for TIO/OLO than FF/UMEC/VI (0.59 vs 0.83, p=0.018). Annualized COPD and/or pneumonia-related emergency department ($370 vs $538, p=0.034) and pharmacy costs ($4692 vs $6573, p<0.001) were lower for TIO/OLO versus FF/UMEC/VI initiators. CONCLUSION: Eight in ten patients with COPD who initiated FF/UMEC/VI had BEC ≤300 cells/μL. TIO/OLO and FF/UMEC/VI users with BEC ≤300 cells/μL experienced similar rates of COPD exacerbations. TIO/OLO initiators incurred lower pharmacy costs related to COPD and/or pneumonia than FF/UMEC/VI initiators. These results support treatment recommendations of reserving inhaled corticosteroids for frequent exacerbators and patients with elevated eosinophil counts.