Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone: A real-world observational study - 07/08/11
, Richard J. Martin, MD c, Neil Barnes, MBBS, FRCP d, Paul Dorinsky, MD e, Elliot Israel, MD f, Nicolas Roche, MD, PhD g, Alison Chisholm, MSc b, Elizabeth V. Hillyer, DVM b, Linda Kemp, BSc b, Amanda J. Lee, PhD h, Julie von Ziegenweidt b, Gene Colice, MD i
Reprint requests: David Price, FRCGP, Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Rd, Aberdeen AB25 2AY, United Kingdom.Abstract |
Background |
Long-term randomized trials comparing asthma outcomes between inhaled corticosteroids in real-world populations are lacking. As such, rigorously conducted observational studies to complement the findings of randomized trials are needed.
Objective |
We sought to compare asthma-related outcomes over 1 year as recorded in a large primary care database for patients aged 5 to 60 years receiving a first prescription (initiation population) or dose increase (step-up population) of hydrofluoroalkane (HFA)-beclomethasone or fluticasone.
Methods |
We used a retrospective matched cohort study in which patients were matched on baseline demographic and disease severity measures. Coprimary outcomes were asthma control (a composite measure comprising no unplanned visit or hospitalization for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and exacerbation rate.
Results |
More than 80% of patients in each population achieved asthma control; 10% and 16% of patients in the initiation and step-up populations, respectively, received add-on or combination therapy during the year. Fluticasone was prescribed at significantly higher doses than HFA-beclomethasone for both populations (P ≤ .001). In the initiation population (n = 1319 in each cohort) the adjusted odds ratio for achieving asthma control with HFA-beclomethasone was 1.30 (95% CI, 1.02-1.65) relative to fluticasone. In the step-up population (cohorts: n = 250) the adjusted odds ratio for achieving asthma control with HFA-beclomethasone was 1.22 (95% CI, 0.66-2.26). Exacerbation rates were similar between cohorts.
Conclusions |
In a real-world setting patients receiving HFA-beclomethasone had a similar or better chance of achieving asthma control at lower prescribed doses than with fluticasone.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, database, fluticasone, hydrofluoroalkane-beclomethasone, inhaled corticosteroid, observational study
Abbreviations used : GPRD, HFA, ICS, MDI, UK
Plan
| Access to data from the General Practice Research Database was funded by Merck & Co, Inc, and the analysis was funded by Teva Pharmaceuticals Limited. |
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| Disclosure of potential conflict of interest: D. Price is a consultant for Aerocrine, Boehringer Ingelheim, Dey Pharmaceuticals, GlaxoSmithKline, Merck, Merck Generics, Sharpe and Dohme, Novartis, Schering-Plough, Teva, Bayer (antibiotic study design); has spoken at meetings sponsored by Boehringer Ingelheim, GlaxoSmithKline, Merck, Sharpe and Dohme, Pfizer, Schering-Plough, Altana Pharma, and Chiesi; has received research support from UK National Health Centre, Aerocrine, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck, Sharpe and Dohme, Novartis, Pfizer, Schering-Plough, and Teva. R. J. Martin is a lecturer and consultant for Teva; is a consultant for AstraZeneca, Novartis/Genentech, Schering, Cypress BioScience, Phase to Phase and Common Health, and the National Heart, Lung, and Blood Institute (NHLBI)/National Institutes of Health (NIH); and has received research support from the NHLBI/NIH. N. Barnes has provided lectured consultancy for GlaxoSmithKline, AstraZeneca, Chiesi, Boehringer, Teva, and Nycomed and has received research support from GlaxoSmithKline, Novartis, and Schering-Plough. E. Israel is a consultant for Abbott, Amgen, Cowen & Co, GlaxoSmithKline, Icagen, MedImmune, Merck, NewMentor, NKT Therapeutics, Ono Pharmaceuticals US, Pulmatrix, Schering-Plough, and Teva Specialty Pharmaceuticals and has received research support from Aerovance, Amgen, Ception Therapeutics, Genentech, Icagen, Johnson & Johnson, MedImmune, National Institutes of Health, and Novartis. E. V. Hillyer has done freelance writing for Merck, Aerocrine, and Teva Sante (France). G. Colice has served as a consultant/speaker for Teva, Dey, BT, GlaxoSmithKline, Vakera, Skye Pharma, and MedImmune and has served as an expert witness on the topic of long-acting β-agonists. The rest of the authors have declared that they have no conflict of interest. |
Vol 126 - N° 3
P. 511 - septembre 2010 Retour au numéro
Article précédent
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