Effectiveness of Single Versus Multiple Inhaler Triple Therapy on Mortality and Cardiopulmonary Risk Reduction in COPD: The SKOPOS-MAZI Study

Michael Pollack; Eleni Rapsomaniki; Antonio Anzueto; Kirsty Rhodes; Nathaniel M Hawkins; Claus F Vogelmeier; Jonathan Marshall; Hana Müllerová

doi:10.1016/j.amjmed.2024.11.007

Effectiveness of Single Versus Multiple Inhaler Triple Therapy on Mortality and Cardiopulmonary Risk Reduction in COPD: The SKOPOS-MAZI Study

Am J Med. 2024 Nov 18:S0002-9343(24)00759-9. doi: 10.1016/j.amjmed.2024.11.007. Online ahead of print.

Authors

Michael Pollack¹, Eleni Rapsomaniki², Antonio Anzueto³, Kirsty Rhodes², Nathaniel M Hawkins⁴, Claus F Vogelmeier⁵, Jonathan Marshall⁶, Hana Müllerová⁷

Affiliations

¹ BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, United States. Electronic address: michael.pollack1@astrazeneca.com.
² BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom.
³ University of Texas Health, South Texas Veterans Health Care System, San Antonio, TX, United States.
⁴ University of British Columbia, Vancouver, British Columbia, Canada.
⁵ University of Marburg, German Center for Lung Research (DZL), Marburg, Hessen, Germany.
⁶ BioPharmaceuticals R&I Medical, AstraZeneca, Cambridge, United Kingdom.
⁷ Respiratory Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom.

PMID: 39566703
DOI: 10.1016/j.amjmed.2024.11.007

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiopulmonary and mortality risk, particularly following exacerbations. While single inhaler triple therapies (SITTs), such as budesonide/glycopyrrolate/formoterol fumarate (BGF), reduce cardiopulmonary risk versus dual bronchodilator therapy, there is limited evidence comparing outcomes with SITTs versus multiple inhaler triple therapies (MITTs).

Methods: SKOPOS-MAZI was a retrospective comparative effectiveness study in patients with COPD aged ≥40 years using US administrative claims data from Optum's de-identified Clinformatics® Data Mart Database. The primary and secondary endpoints were time to all-cause mortality and time to first severe cardiopulmonary event following initiation of BGF or MITT (identification period: October 1, 2020-June 30, 2023; index date: first prescription fill). Relative hazards of outcomes were assessed until a censoring event using Cox proportional hazards models, with inverse propensity treatment weighting accounting for between-group imbalances (standardized mean difference >0.1) in baseline characteristics.

Results: In the primary cohort, risk (hazard ratio [95% confidence intervals]) of all-cause mortality and a first severe cardiopulmonary event were 18% (0.82 [0.75, 0.91]) and 12% (0.88 [0.83, 0.93]) lower in patients initiating BGF versus MITT; results were consistent across censoring definitions, landmark periods, and sensitivity cohorts.

Conclusion: In this real-world comparative effectiveness study of patients with COPD initiating BGF or MITT, BGF was associated with lower all-cause mortality and severe cardiopulmonary event risk versus MITT after accounting for between-group differences in baseline sociodemographic and clinical characteristics, supporting the benefits of BGF over MITT and the need to consider proactive use of SITTs in COPD management.

Keywords: All-cause mortality; Budesonide/glycopyrrolate/formoterol fumarate; Cardiopulmonary; Chronic obstructive pulmonary disease; Comparative effectiveness study; Multiple inhaler triple therapy; Real-world evidence; Single inhaler triple therapy.