Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

Dirkje S Postma, Richard Dekhuijzen, Thys Van Der Molen, Richard J Martin, Wim van Aalderen, Nicolas Roche, Theresa W Guilbert, Elliot Israel, Daniela van Eickels, Javaria Mona Khlaid, Ron M C Herings, Jetty A Overbeek, Cristiana Miglio, Victoria Thomas, Catherine Hutton, Elizabeth V Hillyer, David B. Price

Research output: Contribution to journalArticle

2 Citations (Scopus)
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Abstract

PurposeExtrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone).MethodsThis historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change.ResultsEach cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide.ConclusionsIn this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.
Original languageEnglish
Article numbere45
Pages (from-to)116-125
Number of pages10
JournalAllergy, Asthma & Immunology Research
Volume9
Issue number2
Early online date11 Oct 2016
DOIs
Publication statusPublished - Mar 2017

Keywords

  • anti-asthmatic agents
  • comparative effectiveness research
  • disease exacerbation
  • small airway

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