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. 2020 Feb:162:105859.
doi: 10.1016/j.rmed.2019.105859. Epub 2019 Dec 30.

One-year follow up of asthmatic patients newly initiated on treatment with medium- or high-dose inhaled corticosteroid-long-acting β2-agonist in UK primary care settings

Roland Buhl  1 , Liam G Heaney  2 , Emil Loefroth  3 , Michael Larbig  4 , Konstantinos Kostikas  5 , Valentino Conti  6 , Hui Cao  7
Affiliations
Free article

One-year follow up of asthmatic patients newly initiated on treatment with medium- or high-dose inhaled corticosteroid-long-acting β2-agonist in UK primary care settings

Roland Buhl et al. Respir Med. 2020 Feb.
Free article

Abstract

Introduction: Global Initiative for Asthma (GINA) recommends medium- or high-dose inhaled corticosteroid-long-acting β2-agonist (ICS-LABA) as preferred treatments for patients with moderate-to-severe asthma. Limited data is available on how step 4/5 patients respond to ICS-LABA and how they step up/down in clinical practice.

Methods: This retrospective cohort study assessed the characteristics, control status, treatment pathways, and healthcare resource utilization in patients with asthma during one year after initiating medium- or high-dose ICS-LABA. Data from the United Kingdom Clinical Practice Research Datalink were analysed between January 01, 2006 and February 28, 2016.

Results: Overall, 29,229 and 16,575 patients initiated medium- and high-dose ICS-LABA, and 35.1% and 45.7% of patients, respectively, remained uncontrolled. The proportions of patients who were adherent to treatment (Medication Possession Ratio ≥80%) were 37.8% and 49.1% in the medium- and high-dose ICS-LABA cohorts, respectively. Among these adherent patients, 63.8% in the medium- and 70% in the high-dose cohorts remained uncontrolled. In patients who stepped up therapy in the medium-dose cohort (19.0%), the common step-up choices were add-on leukotriene receptor antagonist (LTRA) (42.2%), long-acting muscarinic antagonist (LAMA) (23.3%), and increase in ICS dose (22.9%). In patients who stepped up therapy in the high-dose cohort (26.1%), the common step-up choices were add-on LAMA (43.8%) and LTRA (42.1%). Healthcare resource utilization was higher in uncontrolled patients, regardless of the ICS-LABA dose.

Conclusions: Many patients remain uncontrolled on both medium- or high-dose ICS-LABA, highlighting the need for timely assessment of asthma control to increase treatment intensity, following evidence-based treatment pathways.

Keywords: Clinical practice research datalink (CPRD); Inhaled corticosteroid-long-acting β(2)-agonist (ICS-LABA); Retrospective study; Treatment pathways; Uncontrolled asthma.

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Conflict of interest statement

Declaration of competing interest RB reports personal fees from AstraZeneca, Chiesi, GSK and Teva, and grants and personal fees from Boehringer Ingelheim, Novartis and Roche. LGH has received grants from Northern Ireland Chest, Heart & Stroke Association and Genentech; has consultant arrangements with Hoffman la Roche, AstraZeneca, Novartis, GlaxoSmithKline, and TEVA; has received grants from/has grants pending with Novartis UK, Roche/Genentech, MedImmune, and GlaxoSmithKline; has received payment for lectures, including service on speakers' bureaus, from Hoffman la Roche, Novartis, and TEVA; and has received travel/accommodation/meeting expenses unrelated to activities listed from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, TEVA, Chiesi, and Napp. EL and HC are employees and shareholders of Novartis. KK and ML were employees of Novartis Pharma AG at the time of conduct of the study. KK has received grants and/or personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, ELPEN, Innovis and Novartis. VC was an employee of Novartis.

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