Initiation of single- and multiple-inhaler triple therapy for COPD and adoption of budesonide/glycopyrrolate/formoterol (BGF): pooled analysis from the AURA Germany study

Triple therapy (TT) is recommended as maintenance treatment for patients who have poorly controlled COPD symptoms or recurring exacerbations. Our objective is to describe characteristics of patients initiating a combination of budesonide/glycopyrrolate/formoterol (BGF) and other TT options to inform on routine care practices. A retrospective study of COPD patients using two German claims sources (WIG2, TG) who initiated single- or multiple-inhaler TT (SITT, MITT) during the identification period: Mar 2021–Dec 2021, including those who switched TTs. Cohorts included patients ≥40 years old, having a diagnosis of COPD and ≥12 months baseline history prior to index date (1st SITT or MITT). Baseline demographics, symptoms, comorbidities, exacerbations, and services were assessed descriptively across TT cohorts. A total of 13514 patients initiated TT (mean age 67.4, 53% male); 1,148 (8.5%) initiated BGF. Baseline comorbidities were similar across cohorts [mean Elixhauser score (range: 6.35 – 7.15; BGF 6.51)]; 88.6% of TT users had ≥1 cardiovascular condition and ≥90% had other upper or lower respiratory conditions/symptoms. A greater percent of BGF users had ≥1 baseline exacerbations (49.7%) vs. 39.4%-48.2% for others; BGF also had greater use of oral corticosteroids (37.5% vs. 20.4%-27.7%). Encounters with pulmonologist were higher for BGF (67%) vs. other TTs (56.1%-62.9%). TT is generally initiated in COPD patients who are inadequately controlled and symptomatic. BGF initiators tended to have greater clinical burden vs. other TT initiators and may indicate a preference to try newer therapies for these patients.