C93-09 Reduction in COPD Exacerbations Following Prompt Triple Therapy Initiation After Hospital Discharge: Results From the Mitos Eros Discharge Study (US)

Rationale

Nearly 40% of patients experiencing severe, hospital-based COPD exacerbation are re-admitted or die within 90 days of discharge. This study investigated whether prompt initiation of single-inhaler triple therapy Budesonide/Glycopyrrolate/Formoterol Fumarate (BGF) after a severe hospital-based COPD exacerbation is associated with a reduction in subsequent exacerbations versus delayed initiation.

Methods

The MITOS EROS DISCHARGE study is a retrospective analysis of patients with COPD from the United States using the Inovalon MORE2 Registry and Medicare Fee-for-Service claims. Inclusion/exclusion criteria were: 1) ≥1 BGF fill on or after 1/1/2021; 2) severe hospital-based COPD exacerbation within 180 days preceding BGF initiation (first exacerbation=index date); 3) continuous health plan enrollment for ≥12 months preceding and ≥1 day following the index date; 4) aged ≥40 years on index date; 5) absence of interstitial fibrosis, sarcoidosis, cancer diagnoses other than basal or squamous cell skin cancer; 6) absence of prior single inhaler triple therapy. Patients were classified into two cohorts based on timing of initiation of BGF following the index exacerbation: prompt (≤30 days) and delayed (31-180 days). Moderate and severe exacerbations were identified using published algorithms, and the unadjusted rate [unAdj 95% CI] of follow-up moderate, severe, and total exacerbations were assessed for each BGF initiation cohort. Additional analyses will be conducted using clone-censoring-weight (CCW) methods to account for potential study biases.

Results

A total of 3,598 patients were eligible for the study: 30.8% prompt (n = 1,109); 69.2% delayed (n = 2,489). The mean±SD age of the sample was 69.5±10.2 years, 64.2% female, most were White (79.3%), covered by Medicare Fee-for-Service (65.7%) with a mean±SD follow-up of 288±99 days. Compared to prompt initiators, delayed initiators had a 28% higher annual rate of total COPD exacerbations (2.85 [2.78, 2.92] vs 2.22 [2.12, 2.33]), driven by a 21% higher rate of moderate exacerbations (2.14 [2.08, 2.21] vs 1.78 [1.69, 1.87]) and a 59% higher rate of severe hospital-based exacerbations (0.71 [0.67, 0.74] vs 0.45 [0.40, 0.49]; Table 1).

Conclusion

Preliminary results indicate prompt initiation of BGF after a severe hospital-based exacerbation was associated with lower annualized rates of subsequent exacerbations, including severe exacerbations compared to delayed initiation. These findings align with the 2026 Global Initiative for Chronic Obstructive Lung Disease (GOLD) discharge recommendations to prescribe triple therapy at discharge, highlighting an opportunity for healthcare providers and health systems to improve outcomes and update clinical pathways by promptly initiating single-inhaler triple therapy after hospitalization.

This abstract is funded by: AstraZeneca