Initiation of single- and multiple-inhaler triple therapy for COPD and adoption of budesonide/glycopyrrolate/formoterol (BGF): insights from primary care in England - the AURA UK study

Triple therapy (TT) is a recommended treatment for patients who have poorly controlled COPD symptoms or recurring exacerbations. Our objective was to describe characteristics of patients initiating a combination of budesonide/glycopyrrolate/formoterol (BGF) and other TT options. AURA UK is a retrospective study of COPD patients using CPRD (Aurum) who initiated single- or multiple-inhaler TT (SITT, MITT) during the identification period: Feb 2021–June 2023. Cohorts included patients ≥35 years old, diagnosed with COPD and ≥12 months baseline history prior index date (1st SITT or MITT). Baseline demographics, symptoms, comorbidities, moderate exacerbations, and treatments were assessed descriptively across TT cohorts. A total of 52418 patients initiated TT (mean age 70.2 years, 51% female, 96% former/current smoker); 2342 (4.5%) initiated BGF. During baseline, 84.6% of BGF had ≥1 respiratory symptoms vs. 67.6%-77.2% for other TT patients. While overall comorbidity was similar across cohorts, BGF patients had greater prevalence of asthma, CVD, CHF, depression, MI, PVD, sleep apnea and stroke. During baseline, 21.3% of TT patients had ≥1 moderate exacerbation (7.5% ≥2) with 29.0% of BGF patients having ≥1 moderate exacerbation (11.8% ≥2). Overall, 55% of TT initiators had oral corticosteroid (OCS) use; 64.5% of BGF with OCS use. Often TT initiators experience symptoms and exacerbations while on dual therapy. Patients initiating BGF tended to have greater clinical burden vs. other TT initiators which may indicate prescriber preference to explore additional therapies to adequately manage their condition.