O4.2.4 Prescribing and availability

Triple therapy prescribing has been increasing since 2016. Retrospective analysis of de-identified administrative data from the US between 2013 and 2018 found that almost three-quarters of patients with COPD who were prescribed triple therapy did not meet guideline recommendations pertaining to prior maintenance therapy and/or exacerbations. Relative to patients prescribed open triple therapy (multiple inhalers collectively containing ICS, LAMA, and LABA), those prescribed closed triple therapy (a fixed-dose single triple therapy inhaler containing fluticasone furoate/umeclidinium/vilanterol) were more likely not to have used ICS, LAMA or LABA and/or their combinations (i.e. maintenance inhaler naïve) and to have no evidence of at least 2 moderate or one severe exacerbation prior to initiating triple therapy. This guideline-discordant prescribing behaviour occurred more often among generalist-specialty prescribers than pulmonologists. Increasing prescriber awareness of guideline recommendations is warranted to counter the continuing overprescribing of triple therapy in individuals with COPD (Bhatt 2022) [evidence level III-2].

In Australia, the fixed-dose triple therapy combination ICS/LABA/LAMA that are subsidised through the PBS (also eligible for 60-day prescriptions) include:

However, access to these subsidised medications on the PBS are subject to certain criteria. To be eligible for PBS-subsidised triple therapy (ICS/LABA/LAMA), patients must have experienced:

  • at least one severe COPD exacerbation, which required hospitalisation, or 2 or more moderate exacerbations in the previous 12 months, with significant symptoms despite regular bronchodilator therapy with a LAMA and a LABA or an ICS and a LABA:
    OR
  • the patient must have been stabilised on a combination of a LAMA, LABA and an ICS for COPD.