المؤلفون: Hanania, Nicola A, Settipane, Russell A, Khoury, Samir, Shaikh, Asif, Dotiwala, Zenobia, Casciano, Julian, Foggs, Michael B

المصدر: All Other Contributions

مصطلحات موضوعية: Tiotropium Bromide, Adrenergic beta-2 Receptor Agonists, Asthma, Adrenal Cortex Hormones, Muscarinic Antagonists, Chronic Obstructive Pulmonary Disease, Bronchodilator Agents, Immunology, Pulmonary Medicine

الوصف: Background: Based on current clinical guidelines, long-acting β2-agonists (LABA) are frequently prescribed before long-acting muscarinic antagonists (LAMA) as an add-on to inhaled corticosteroids (ICS) in uncontrolled asthma. However, there is insufficient real-world evidence that supports this therapeutic approach. Objective: The objective was to compare asthma exacerbations and healthcare resource utilization in patients with asthma using the LAMA tiotropium bromide (Tio) or a LABA as an add-on to ICS (ICS + Tio or ICS/LABA) in a real-world setting. Methods: This retrospective, observational study included patients aged ≥12 years with asthma diagnoses identified in a U.S. longitudinal claims database (October 2015 to August 2020). The ICS + Tio and ICS/LABA cohorts were 1:2 propensity score matched for baseline variables. Outcomes were compared in the postmatched cohorts, and the risk of exacerbation was evaluated by using Kaplan-Meier curves. Results: After propensity score matching, there were 633 and 1266 patients in the ICS + Tio and ICS/LABA cohorts, respectively. The proportion of patients who experienced a severe or a moderate-or-severe exacerbation during follow-up was similar between the ICS + Tio versus ICS/LABA cohorts (4% versus 3%, p = 0.472, and 50% versus 45%, p = 0.050, respectively). The mean time to first severe (ICS + Tio 43.8 days versus ICS/LABA 49.4 days, p = 0.758) and moderate-or-severe exacerbation (ICS + Tio 65.8 days versus ICS/LABA 58.9 days, p = 0.474) was not statistically different between cohorts. The treatments had no effect on the risk of severe exacerbation, although it was 36% lower in ICS + Tio users than in ICS/LABA users (hazard ratio 0.64 [95% confidence interval, 0.22-1.84]). All-cause and asthma-related average monthly healthcare resource utilization were comparable between the treatments for hospitalizations and emergency department visits but were significantly greater in the ICS + Tio cohort than in the ICS/LABA cohort for asthma-related outpatient visits (p < ...

العلاقة: https://institutionalrepository.aah.org/allother/665Test; https://libkey.io/libraries/1712/10.2500/aap.2023.44.230060Test

الإتاحة: https://doi.org/10.2500/aap.2023.44.230060Test
https://institutionalrepository.aah.org/allother/665Test

المؤلفون: Casale, Thomas B, Foggs, Michael B, Balkissoon, Ronald C

المصدر: All Other Contributions

مصطلحات موضوعية: Asthma, long-acting muscarinic antagonists, management, Immunology

الوصف: Patients with asthma who are suboptimally responsive to inhaled corticosteroids (ICS) and long-acting β-agonists (LABAs) are frequently exposed to oral corticosteroids and high-dose ICS, which can lead to significant side effects. Long-acting muscarinic antagonists (LAMAs) have demonstrated efficacy and safety in a subset of these patients. This review summarizes the results of key studies using LAMAs in patients with asthma aged 12 years or older. LAMA as an add-on treatment improved lung function and asthma control in patients with uncontrolled asthma across studies. The efficacy of LAMAs as an add-on to ICS was superior to that of placebo and ICS dose escalation and comparable with that of LABAs. LAMA plus ICS plus LABA provided modest improvements in bronchodilation and increased the time to first severe exacerbation versus ICS plus LABA. Single-inhaler triple therapy was associated with decreased health care resource utilization and improved cost-effectiveness versus multiple inhalers. LAMAs were generally well tolerated; asthma exacerbations, bronchitis, and nasopharyngitis were common adverse events with LAMA in combination with ICS alone or ICS plus LABA. Thus, the overall evidence presented in this review supports the use of add-on LAMA treatment as a reasonable option in patients with asthma uncontrolled with ICS plus LABA or ICS alone.

العلاقة: https://institutionalrepository.aah.org/allother/305Test; https://libkey.io/libraries/1712/10.1016/j.jaci.2022.06.015Test

الإتاحة: https://doi.org/10.1016/j.jaci.2022.06.015Test
https://institutionalrepository.aah.org/allother/305Test