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Boulet LP, Abbott C, Brusselle G, Edwards D, Oppenheimer J, Pavord ID, Pizzichini E, Sagara H, Slade D, Wechsler ME, Gibson PG. Baseline Characteristics and ICS/LAMA/LABA Response in Asthma: Analyses From the CAPTAIN Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1244-1253.e8. [PMID: 38309696 DOI: 10.1016/j.jaip.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/27/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Findings from CAPTAIN (NCT02924688) suggest that treatment response to fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) differs according to baseline type 2 inflammation markers in patients with moderate to severe asthma. Understanding how other patient physiologic and clinical characteristics affect response to inhaled therapies may guide physicians toward a personalized approach for asthma management. OBJECTIVE To investigate, using CAPTAIN data, the predictive value of key demographic and baseline physiologic variables in patients with asthma (lung function, bronchodilator reversibility, age, age at asthma onset) on response to addition of the long-acting muscarinic antagonist UMEC to inhaled corticosteroid/long-acting β2-agonist combination FF/VI, or doubling the FF dose. METHODS Prespecified and post hoc analyses of CAPTAIN data were performed using categorical and continuous variables of key baseline characteristics to understand their influence on treatment outcomes (lung function [trough FEV1], annualized rate of moderate/severe exacerbations, and asthma control [Asthma Control Questionnaire]) following addition of UMEC to FF/VI or doubling the FF dose in FF/VI or FF/UMEC/VI. RESULTS Adding UMEC to FF/VI led to greater improvements in trough FEV1 versus doubling the FF dose across all baseline characteristics assessed. Doubling the FF dose was generally associated with numerically greater reductions in the annualized rate of moderate/severe exacerbations compared with adding UMEC, independent of baseline characteristics. Adding UMEC and/or doubling the FF dose generally led to improvements in Asthma Control Questionnaire scores irrespective of baseline characteristics. CONCLUSIONS Unlike previous findings with type 2 biomarkers, lung function, bronchodilator reversibility, age and age at asthma onset do not appear to predict response to inhaled therapy.
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Affiliation(s)
| | | | | | | | | | | | - Emilio Pizzichini
- GSK, Brentford, Middlesex, United Kingdom; Federal University of Santa Catarina, Santa Catarina, Brazil
| | | | | | | | - Peter G Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Centre of Excellence in Severe Asthma, University of Newcastle, Newcastle, New South Wales, Australia
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Fukuda Y, Homma T, Sagara H. Clinical inertia in asthma. NPJ Prim Care Respir Med 2023; 33:34. [PMID: 37838773 PMCID: PMC10576819 DOI: 10.1038/s41533-023-00356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023] Open
Abstract
Despite advances in pharmaceutical treatment in recent years, a relatively high proportion of patients with asthma do not have adequate asthma control, causing chronic disability, poor quality of life, and multiple emergency department visits and hospitalizations. A multifaceted approach is needed to overcome the problems with managing asthma, and clinical inertia (CI) is a crucial concept to assist with this approach. It divides clinical inertia into three main categories, which include healthcare provider-related, patient-related, and healthcare system-related CI. The strategies to overcome these CI are complex, and the M-GAP approach, which combines a multidisciplinary approach, dissemination of guidelines, utilization of applications, and development and promotion of low-cost prescriptions, will help clinicians.
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Affiliation(s)
- Yosuke Fukuda
- Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, 6663-1 Funatsu, Fujikawaguchiko-machi, Yamanashi, Japan.
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
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Wechsler ME, Oppenheimer JJ. Open-inhaler versus single-inhaler triple therapy (long-acting muscarinic antagonist, inhaled corticosteroid, and long-acting β 2-agonist) in asthma patients: a narrative review. J Asthma 2023; 60:1633-1645. [PMID: 36964764 DOI: 10.1080/02770903.2023.2188556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/09/2023] [Accepted: 03/04/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To review the evidence for the use of open-inhaler (inhaled corticosteroid [ICS] plus long-acting β2-agonist [LABA] with separate add-on long-acting muscarinic antagonist [LAMA]) versus single-inhaler triple therapy (ICS/LABA/LAMA combination) and the merits of add-on LAMA to ICS/LABA in patients with uncontrolled asthma. DATA SOURCES Original research articles were identified from PubMed using the search term "triple therapy asthma." Information was also retrieved from the ClinicalTrials.gov website. STUDY SELECTIONS Articles detailing the use of add-on LAMA to ICS plus LABA (open-inhaler triple therapy), and closed triple therapy compared with ICS plus LABA dual therapy, addressing patient symptoms, exacerbations, and health-related quality of life. RESULTS Open-inhaler triple therapy was associated with a significantly reduced incidence of hospitalizations and emergency department visits and a decrease in ICS dose, oral corticosteroids use, and antibiotics use. Exacerbations and acute respiratory events were also reduced. Single-inhaler triple therapy showed a greater improvement in lung function, asthma control, and health status and was noninferior to open-inhaler triple therapy for Asthma Quality of Life Questionnaire scores. Single-inhaler triple therapy may also lead to improved therapy adherence. CONCLUSION Add-on LAMA to ICS plus LABA (open- or single-inhaler triple therapy) improves the response in patients who remain symptomatic and provides a reasonable alternative to ICS dose escalation in treatment-refractory patients.
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Affiliation(s)
- Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - John J Oppenheimer
- Pulmonary and Allergy Associates, Morristown; UMDNJ-Rutgers, Newark, NJ, USA
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Liu X, Yu Y, Wu Y, Luo A, Yang M, Li T, Li T, Mao B, Chen X, Fu J, Jiang H, Liu W. A systematic pharmacology-based in vivo study to reveal the effective mechanism of Yupingfeng in asthma treatment. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 114:154783. [PMID: 37004399 DOI: 10.1016/j.phymed.2023.154783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The clinical effect of Yupingfeng (YPF) has been confirmed in asthma patients, however, it lacks a study to verify its pharmacological mechanism. HYPOTHESIS/PURPOSE To reveal the molecular basis and potential pharmacological mechanism of YPF in the treatment of asthma. STUDY DESIGN AND METHODS First, a systems pharmacology-based method integrating pharmacokinetic screening, target prediction, network analyses, GO and KEGG analyses were used for the systematic deciphering of the mechanism of YPF in asthma. Second, differentially expressed genes (DEGs) between asthma patients and healthy controls were identified by GEO2R online tool. Third, based on systems pharmacology and DEGs results, molecular docking was performed utilizing the Discovery Studio 2020 Client version to detect the binding capacity between compounds and targets. Finally, ovalbumin (OVA)-challenged C57BL/6 mice were treated with YPF or its effective compound to assess the predictions. RESULTS A total of 35 active compounds were filtered out, with 87 potential targets being identified for further analysis after target fishing and matching. Quercetin, kaempferol, and wogonin were identified as the main ingredients in YPF. The signaling pathways of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT), tumor necrosis factor (TNF) and IL-17 were identified as the top signaling pathways in KEGG enrichment analysis. GEO2R tools of NCBI discovered five DEGs that overlapped with the therapeutic targets of YPF. Wogonin was proven to be the top active compound in YPF through the results of molecular docking. In vivo experiments indicated that YPF and wogonin significantly attenuated airway resistance and lung inflammation by decreasing the levels of inflammatory cytokines and key factors in PI3K/AKT, IL-17, and TNF signaling pathways. CONCLUSIONS YPF and its main active compound wogonin may exert some therapeutic effects on asthma inflammation through multiple molecular targets and signaling pathways including PI3K/AKT, IL-17 and TNF-α.
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Affiliation(s)
- Xuemei Liu
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China; Department of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital, Sichuan University, 1 Keyuansi Road, Chengdu, Sichuan, PR. China
| | - Yan Yu
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Yanqing Wu
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Ai Luo
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China; Department of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital, Sichuan University, 1 Keyuansi Road, Chengdu, Sichuan, PR. China
| | - Mei Yang
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Ting Li
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Tingqian Li
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Bing Mao
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Xiaoting Chen
- Animal Experimental Center, West China Hospital, Sichuan University, 1 Keyuansi Road, Chengdu, Sichuan, PR. China
| | - Juanjuan Fu
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Hongli Jiang
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China
| | - Wei Liu
- Division of Pulmonary Diseases, Institute of Integrated Traditional and Western Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, PR. China; Department of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital, Sichuan University, 1 Keyuansi Road, Chengdu, Sichuan, PR. China.
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Zhang S, White J, Hunter AG, Hinds D, Fowler A, Gardiner F, Slade D, Murali S, Meeraus W. Suboptimally controlled asthma in patients treated with inhaled ICS/LABA: prevalence, risk factors, and outcomes. NPJ Prim Care Respir Med 2023; 33:19. [PMID: 37156824 PMCID: PMC10167343 DOI: 10.1038/s41533-023-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/02/2023] [Indexed: 05/10/2023] Open
Abstract
This observational claims-linked survey study assessed the prevalence of and risk factors for suboptimal asthma control and healthcare utilization in adults with asthma receiving fixed-dose combination (FDC) inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). Commercially insured adults from the Optum Research Database were invited to complete the Asthma Control Test (ACT) and Asthma Control Questionnaire-6 (ACQ-6). Among participants (N = 428), 36.4% (ACT-assessed) and 55.6% (ACQ-6-assessed) had inadequately controlled asthma. Asthma-related quality of life was worse and asthma-related healthcare resource utilization was higher in poorly controlled asthma. Factors associated with ACT-defined suboptimal asthma control in multivariate analysis included: frequent short-acting β2-agonist (SABA) use, asthma-related outpatient visits, lower treatment adherence, and lower education levels. During follow-up, factors associated with asthma exacerbations and/or high SABA use included: inadequately controlled asthma (ACT-assessed), body mass index ≥30 kg/m2, and high-dose ICS/LABA. Approximately 35-55% of adults with asthma were inadequately controlled despite FDC ICS/LABA; poor control was associated with worse disease outcomes.
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Davitte J, DeBarmore B, Hinds D, Zhang S, Chao J, Sansbury L. Asthma control among treated US asthma patients in Practice Fusion's electronic medical record research database. NPJ Prim Care Respir Med 2023; 33:17. [PMID: 37105985 PMCID: PMC10140050 DOI: 10.1038/s41533-023-00338-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/10/2023] [Indexed: 04/29/2023] Open
Abstract
This study investigated burden of 'not well-controlled' asthma, overall and by Global Initiative for Asthma (GINA) Step, among treated asthma patients in Practice Fusion's research database. Asthma control (Asthma Control Test [ACT]) was stratified by GINA Step; prevalence ratios were estimated using Poisson regression with robust variance controlled for confounders. ACT scores ≤19 reflect not well-controlled; >19 reflect 'well-controlled' asthma. Of 15,579 patients, 30% had not well-controlled asthma at index date. The proportion of patients with not well-controlled asthma increased from GINA Step 1 (29%) to Step 5 (45%). Compared with Step 1, the proportion of patients with not well-controlled asthma was 0.87-times lower in Step 2, 1.10-times greater in Step 4, and 1.37-times greater in Step 5. Results suggest that despite available treatments, patients remain symptomatic across GINA Steps in real-world primary care and specialist outpatient practices, with incremental disease burden and unmet medical need in these populations.
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Affiliation(s)
- Jonathan Davitte
- Value Evidence and Outcomes Data, Methods, and Analytics, GSK, Collegeville, PA, USA
| | - Bailey DeBarmore
- Real World Evidence and Epidemiology, GSK, Collegeville, PA, USA
| | - David Hinds
- Real World Evidence and Epidemiology, GSK, Collegeville, PA, USA
| | - Shiyuan Zhang
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA.
| | - Jessica Chao
- Value Evidence and Outcomes Data, Methods, and Analytics, GSK, Collegeville, PA, USA
| | - Leah Sansbury
- Real World Evidence and Epidemiology, GSK, Collegeville, PA, USA
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Baccelli A, Koćwin M, Parazzini EM, Rinaldo RF, Centanni S. Long-Term Outcomes of Combination Biologic Therapy in Uncontrolled Severe Asthma: A Case Study. J Asthma 2022; 60:1050-1053. [PMID: 35913268 DOI: 10.1080/02770903.2022.2109162] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Introduction. Treatment with biologics has significantly reduced the social and economic burden of severe asthma. However, some patients may still feature a suboptimal control of their symptoms while on therapy. In this subset of asthmatic patients, a benefit from a dual biologic therapy has sporadically been reported in literature. Our aim is to add our experience to the limited body of evidence supporting combination biologic therapies.Case study. Here we present the case of a 68-year-old nonsmoker female, with an allergic and eosinophilic corticosteroid-dependent severe asthma. She displayed well controlled comorbidities and good adherence to the inhaled therapy. Omalizumab was started in 2008 with an initial remarkable clinical improvement. After nine years of biologic therapy, she reported a gradual worsening of her symptoms and exacerbations. Mepolizumab was then added in 2019.Results. The addition of Mepolizumab resulted in a meaningful amelioration of her quality of life, asthma control, number of exacerbations and 6-minute-walking-distance at three-year follow-up. The average Prednisone dosage was tapered from 25 mg to 20 mg daily. No adverse events were observed since the introduction of the second biologic.Conclusion. Our experience indicates that Mepolizumab may be beneficial and safe as an add-on biologic in a patient whose allergic and eosinophilic asthma remains uncontrolled despite treatment with an anti-IgE strategy. Further studies on a larger number of patients are required to demonstrate whether the positive outcomes published so far are replicable on a larger scale.
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Affiliation(s)
- Andrea Baccelli
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Marcelina Koćwin
- Department of Internal Medicine, Asthma and Allergy; Norbert Barlicki Memorial Teaching Hospital No. 1; Medical University of Lodz, Lodz, Poland
| | - Elena M Parazzini
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Rocco F Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy
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Oppenheimer J, Hoyte FCL, Phipatanakul W, Silver J, Howarth P, Lugogo NL. Allergic and eosinophilic asthma in the era of biomarkers and biologics: similarities, differences and misconceptions. Ann Allergy Asthma Immunol 2022; 129:169-180. [PMID: 35272048 DOI: 10.1016/j.anai.2022.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Severe asthma is associated with substantial personal and economic burden; maintaining disease control is the key management goal. Increased understanding of asthma heterogeneity and development of type 2 (T2)-targeting biologics has substantially advanced disease management and outcomes; however, despite both being driven by T2 inflammation, allergic and eosinophilic asthma have different treatment recommendations. We sought to better understand the similarities and differences between allergic and eosinophilic asthma and highlight where misconceptions may arise. DATA SOURCES Published articles, pivotal trials, post hoc analyses, and asthma clinical guidelines sourced from PubMed. STUDY SELECTIONS Sources reporting allergic and eosinophilic asthma classifications, disease mechanisms, and biomarkers associated with treatment response. RESULTS This review highlights that severe allergic and eosinophilic asthma are both driven by T2 inflammation with eosinophils playing a cardinal role. Despite this overlap, treatment recommendations differ based on asthma classification. T2 cytokine gene expression is a reasonably well-established research tool, but not a well-established biomarker in clinical practice, unlike blood eosinophil counts, fractional exhaled nitric oxide, and immunoglobulin E; the clinical relevance of immunoglobulin E as a predictive biomarker remains unclear. CONCLUSION Asthma classifications that can be easily characterized at patient level to ensure accurate diagnosis, predict disease trajectory, and treatment response are required. The current dichotomy of allergic and eosinophilic asthma classifications is likely too simplistic, given the similar eosinophil-mediated disease pathophysiology in both classifications. Our results provide future directions to guide clinically meaningful interpretation of asthma endophenotypes, which may improve understanding of severe asthma characterization and aid future advances in defining responders more precisely with personalized medicine approaches.
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Affiliation(s)
| | - Flavia C L Hoyte
- National Jewish Health and University of Colorado, Denver, Colorado
| | - Wanda Phipatanakul
- Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Jared Silver
- US Medical Affairs-Respiratory, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Peter Howarth
- Respiratory Medical Franchise, GlaxoSmithKline, Brentford, United Kingdom
| | - Njira L Lugogo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
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Averell CM, Laliberté F, Germain G, Duh MS, Lima R, Mahendran M, Slade DJ. Symptom control in patients with asthma using inhaled corticosteroids/long-acting β 2-agonists (fluticasone furoate/vilanterol or budesonide/formoterol) in the US: a retrospective matched cohort study. J Asthma 2021; 59:1805-1818. [PMID: 34375568 DOI: 10.1080/02770903.2021.1963767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Treatment with fluticasone furoate/vilanterol (FF/VI), an inhaled corticosteroid/long-acting β2-agonist therapy, reduces the risk of severe asthma exacerbations and improves lung function and symptom control in patients with asthma. However, real-world data remain limited among asthma patients in the United States (US).Methods: This retrospective cohort study propensity score (PS) matched adult asthma patients initiating once-daily FF/VI 100/25 mcg with patients initiating twice-daily budesonide/formoterol (B/F) 160/4.5 mcg using a US claims database (01/01/2015-12/31/2018). Asthma control was measured by the mean number of short-acting β2-agonist (SABA) canisters dispensed per patient-year (PPY) during follow-up. Time to first, and rates of, overall and severe asthma exacerbations were also measured.Results: After PS matching, 18531 patients receiving FF/VI were matched to 18531 patients receiving B/F. Mean SABA canisters dispensed PPY was significantly lower for FF/VI compared with B/F users (FF/VI: 1.47, B/F: 1.64; p < 0.001). FF/VI use resulted in 13% significantly lower risk of having an overall asthma-related exacerbation and 22% lower risk of a severe exacerbation versus B/F use (overall exacerbation hazard ratio [HR] [95% confidence interval (CI)]: 0.87 [0.82-0.92], p < 0.001; severe exacerbation HR: 0.78 [0.63-0.97], p = 0.027). Asthma-related exacerbation rates per 100 patient-days were also significantly lower for the FF/VI compared with B/F group (overall: 0.0475 vs. 0.0558, p < 0.001; severe 0.0026 vs. 0.0033, p = 0.020).Conclusions: In real-world practice, initiation of once-daily FF/VI 100/25 mcg in adults with asthma was associated with lower use of SABA and fewer asthma-related exacerbations, which may indicate better asthma control, when compared with use of twice-daily B/F 160/4.5 mcg.
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Affiliation(s)
- Carlyne M Averell
- US Value, Evidence and Outcomes, GlaxoSmithKline plc, Research Triangle Park, NC, United States
| | - François Laliberté
- Health Economics and Outcomes Research; Groupe d'analyses, Ltée, Montréal, QC, Canada
| | - Guillaume Germain
- Health Economics and Outcomes Research; Groupe d'analyses, Ltée, Montréal, QC, Canada
| | - Mei Sheng Duh
- Health Economics and Outcomes Research, Analysis Group, Inc, Boston, MA, United States
| | - Robson Lima
- US Medical Affairs, GlaxoSmithKline plc, Research Triangle Park, NC, United States
| | - Malena Mahendran
- Health Economics and Outcomes Research; Groupe d'analyses, Ltée, Montréal, QC, Canada
| | - David J Slade
- Clinical Sciences, GlaxoSmithKline plc, Research Triangle Park, NC, United States
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Ciprandi G, Tosca MA. House dust mites-driven allergic rhinitis: could its natural history be modified? Expert Rev Clin Immunol 2021; 17:109-114. [PMID: 33472013 DOI: 10.1080/1744666x.2021.1879642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) is the most common IgE-mediated disease. House dust mites (HDMs)-sensitization is the main cause of AR. HDM-driven AR is characterized by a typical natural history consisting of possible progression to asthma. Allergen Immunotherapy (AIT) is, at present, a unique treatment to modify the natural history of allergic diseases. Tablets AIT (TAIT) represents a new era in AIT. There is evidence that TAIT could prevent asthma in AR patients. AREAS COVERED The literature search methodology was based on the articles cited by PubMed from 1980 to 2020. AIT's rationale is to restore an immunological and, consequently, clinical tolerance toward the causal allergen. The progression from rhinitis to asthma may be influenced by a relevant risk factor, such as the persistent type 2 inflammation of airways. HDMs are perennial allergens and allergen exposure is the condicio sine qua non to maintain inflammation. AIT could modify the progression toward asthma restoring physiologic immune response to the causal allergen and consequently dampening type 2 inflammation. EXPERT OPINION Patients with HDM-driven AR are susceptible to develop asthma over time. Many studies explored this topic. Cross-sectional and longitudinal studies identified some markers which predict the risk of developing asthma. They include bronchial airflow limitation, bronchial hyperresponsiveness, type 2 inflammation, and rhinitis duration. TAIT could block this progression by acting on this vicious circle. Future studies should explore this issue using adequate methodology.
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Affiliation(s)
- Giorgio Ciprandi
- Outpatients Department, Consultant Allergist, Casa Di Cura Villa Montallegro, Genoa, Italy
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