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BRIEF RESEARCH REPORT article

Front. Pharmacol.

Sec. Pharmacoepidemiology

Volume 16 - 2025 | doi: 10.3389/fphar.2025.1642470

Single-versus multiple-inhaler triple therapy in patients with COPD in Spain: a retrospective cohort study comparing adherence, persistence, risk of exacerbations and economic outcomes

Provisionally accepted
M. Asunción González-GonzálezM. Asunción González-González1M. Aránzazu Pedrosa-NaudínM. Aránzazu Pedrosa-Naudín1Diego Fernández LázaroDiego Fernández Lázaro2Isabel Díaz PlanellesIsabel Díaz Planelles3F. Javier ÁlvarezF. Javier Álvarez2,4Eduardo Gutiérrez-AbejónEduardo Gutiérrez-Abejón1,2,3,4*
  • 1Junta de Castilla y Leon Consejeria de Sanidad, Valladolid, Spain
  • 2Universidad de Valladolid Facultad de Medicina, Valladolid, Spain
  • 3Universidad Internacional de La Rioja, Logroño, Spain
  • 4Gerencia de Salud de Area de Valladolid, Valladolid, Spain

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This retrospective study aimed to compare the clinical and economic outcomes of single-inhaler triple therapy (SITT) versus multiple-inhaler triple therapy (MITT) in a large cohort of COPD patients. Metrics on adherence, prevalence, and incidence of exacerbations in COPD patients treated with SITT or MITT were analyzed using pharmacy claims data integrated with the Spanish public health database. At the 12-month follow-up, patients in the SITT cohort were significantly more adherent (75.22% vs 70.1%; OR=1.33), more persistent (64.32% vs 52.4%; HR=1.56) and had a lower incidence of moderate exacerbations (53.53% vs 64.07%; OR=0.65) than patients in the MITT cohort. The main predictors associated with lack of persistence were being a naïve patient (HR=0.55) and moderate exacerbations (HR=0.85). Furthermore, medication costs were lower for SITT (EUR 909.31 vs. EUR 1025.31), demonstrating its cost-effectiveness. Our results suggest that SITT not only may improve adherence and persistence but also contributes to a relevant reduction in the risk of moderate exacerbations. Additionally, SITT offers a more cost-effective alternative for patients with moderate to severe COPD with documented exacerbations, making it a valuable strategy in real-world clinical practice.

Keywords: chronic obstructive pulmonary disease, multiple-inhaler triple therapy, Single-inhaler triple therapy, adherence, Persistence, Exacerbations

Received: 06 Jun 2025; Accepted: 01 Sep 2025.

Copyright: © 2025 González-González, Pedrosa-Naudín, Fernández Lázaro, Díaz Planelles, Álvarez and Gutiérrez-Abejón. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Eduardo Gutiérrez-Abejón, Junta de Castilla y Leon Consejeria de Sanidad, Valladolid, Spain

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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