Comparative Effectiveness of Step-up Therapies in Children with Asthma Prescribed Inhaled Corticosteroids: A Historical Cohort Study

Claire S. Murray, Mike Thomas, Kathryn Richardson, David B. Price, Steve W. Turner

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6 Citations (Scopus)
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Abstract

Background
In children with uncontrolled asthma prescribed low-dose inhaled corticosteroids (ICSs), various step-up options are available: fixed-dose combination ICS/long-acting β2-agonist (FDC), increasing ICS dose, or adding leukotriene receptor antagonist (LTRA). However, evidence of their relative effectiveness is limited.

Objective
To compare the effectiveness of step-up treatment to FDC in children with asthma versus increased ICS dose, or LTRA.

Methods
This matched cohort study used UK primary-care databases to study children prescribed their first step-up treatment to FDC, increased ICS dose, or LTRA. A year of baseline data was used for matching and identifying confounders. Outcomes over the following year were examined. The primary outcome was severe exacerbation rate; secondary outcomes included overall asthma control, derived from databases (no asthma-related admissions/hospital attendances/oral corticosteroids or antibiotics prescribed with a respiratory review, and average prescribed salbutamol ≤200 μg/day).

Results
There were 971 matched pairs in the FDC and increased ICS dose cohorts (59% males; mean age, 9.4 years) and 785 in the FDC and LTRA cohorts (60% males; mean age, 9.0 years). Exacerbation rates in the outcome year were similar between FDC and increased ICS (adjusted incidence rate ratio [95% CI], 1.09 [0.75-1.59]) and FDC and LTRA (incidence rate ratio, 1.36 [0.93-2.01]). Increased ICS and LTRA significantly reduced the odds of achieving overall asthma control, compared with FDC (odds ratios [95% CI], 0.52 [0.42-0.64] and 0.53 [0.42-0.66], respectively)—this was driven by reduced short-acting beta-agonist use.

Conclusions
FDC is as effective as increased ICS or LTRA in reducing severe exacerbation rate, but more effective in achieving asthma control.
Original languageEnglish
Pages (from-to)1082-1090
Number of pages9
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Volume5
Issue number4
Early online date27 Mar 2017
DOIs
Publication statusPublished - Jul 2017

Fingerprint

Leukotriene Antagonists
Adrenal Cortex Hormones
Cohort Studies
Asthma
Steroid Receptors
Therapeutics
Databases
Albuterol
Incidence
Primary Health Care
Odds Ratio
Anti-Bacterial Agents

Keywords

  • asthma
  • child
  • inhaled cortocosteroid
  • leukotriene receptor antagonist
  • long-acting beta-agonist
  • step-up therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{1e01ff01855c42849a95f4e88b2805d9,
title = "Comparative Effectiveness of Step-up Therapies in Children with Asthma Prescribed Inhaled Corticosteroids: A Historical Cohort Study",
abstract = "BackgroundIn children with uncontrolled asthma prescribed low-dose inhaled corticosteroids (ICSs), various step-up options are available: fixed-dose combination ICS/long-acting β2-agonist (FDC), increasing ICS dose, or adding leukotriene receptor antagonist (LTRA). However, evidence of their relative effectiveness is limited.ObjectiveTo compare the effectiveness of step-up treatment to FDC in children with asthma versus increased ICS dose, or LTRA.MethodsThis matched cohort study used UK primary-care databases to study children prescribed their first step-up treatment to FDC, increased ICS dose, or LTRA. A year of baseline data was used for matching and identifying confounders. Outcomes over the following year were examined. The primary outcome was severe exacerbation rate; secondary outcomes included overall asthma control, derived from databases (no asthma-related admissions/hospital attendances/oral corticosteroids or antibiotics prescribed with a respiratory review, and average prescribed salbutamol ≤200 μg/day).ResultsThere were 971 matched pairs in the FDC and increased ICS dose cohorts (59{\%} males; mean age, 9.4 years) and 785 in the FDC and LTRA cohorts (60{\%} males; mean age, 9.0 years). Exacerbation rates in the outcome year were similar between FDC and increased ICS (adjusted incidence rate ratio [95{\%} CI], 1.09 [0.75-1.59]) and FDC and LTRA (incidence rate ratio, 1.36 [0.93-2.01]). Increased ICS and LTRA significantly reduced the odds of achieving overall asthma control, compared with FDC (odds ratios [95{\%} CI], 0.52 [0.42-0.64] and 0.53 [0.42-0.66], respectively)—this was driven by reduced short-acting beta-agonist use.ConclusionsFDC is as effective as increased ICS or LTRA in reducing severe exacerbation rate, but more effective in achieving asthma control.",
keywords = "asthma, child , inhaled cortocosteroid, leukotriene receptor antagonist , long-acting beta-agonist, step-up therapy",
author = "Murray, {Claire S.} and Mike Thomas and Kathryn Richardson and Price, {David B.} and Turner, {Steve W.}",
note = "This work was supported by the Respiratory Effectiveness Group. Acknowledgments We thank the Respiratory Effectiveness Group for funding this work, Annie Burden for assistance with statistics, and Simon Van Rysewyk and Lisa Law for assistance with medical writing.",
year = "2017",
month = "7",
doi = "10.1016/j.jaip.2016.12.028",
language = "English",
volume = "5",
pages = "1082--1090",
journal = "The Journal of Allergy and Clinical Immunology: In Practice",
issn = "2213-2198",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Comparative Effectiveness of Step-up Therapies in Children with Asthma Prescribed Inhaled Corticosteroids

T2 - A Historical Cohort Study

AU - Murray, Claire S.

AU - Thomas, Mike

AU - Richardson, Kathryn

AU - Price, David B.

AU - Turner, Steve W.

N1 - This work was supported by the Respiratory Effectiveness Group. Acknowledgments We thank the Respiratory Effectiveness Group for funding this work, Annie Burden for assistance with statistics, and Simon Van Rysewyk and Lisa Law for assistance with medical writing.

PY - 2017/7

Y1 - 2017/7

N2 - BackgroundIn children with uncontrolled asthma prescribed low-dose inhaled corticosteroids (ICSs), various step-up options are available: fixed-dose combination ICS/long-acting β2-agonist (FDC), increasing ICS dose, or adding leukotriene receptor antagonist (LTRA). However, evidence of their relative effectiveness is limited.ObjectiveTo compare the effectiveness of step-up treatment to FDC in children with asthma versus increased ICS dose, or LTRA.MethodsThis matched cohort study used UK primary-care databases to study children prescribed their first step-up treatment to FDC, increased ICS dose, or LTRA. A year of baseline data was used for matching and identifying confounders. Outcomes over the following year were examined. The primary outcome was severe exacerbation rate; secondary outcomes included overall asthma control, derived from databases (no asthma-related admissions/hospital attendances/oral corticosteroids or antibiotics prescribed with a respiratory review, and average prescribed salbutamol ≤200 μg/day).ResultsThere were 971 matched pairs in the FDC and increased ICS dose cohorts (59% males; mean age, 9.4 years) and 785 in the FDC and LTRA cohorts (60% males; mean age, 9.0 years). Exacerbation rates in the outcome year were similar between FDC and increased ICS (adjusted incidence rate ratio [95% CI], 1.09 [0.75-1.59]) and FDC and LTRA (incidence rate ratio, 1.36 [0.93-2.01]). Increased ICS and LTRA significantly reduced the odds of achieving overall asthma control, compared with FDC (odds ratios [95% CI], 0.52 [0.42-0.64] and 0.53 [0.42-0.66], respectively)—this was driven by reduced short-acting beta-agonist use.ConclusionsFDC is as effective as increased ICS or LTRA in reducing severe exacerbation rate, but more effective in achieving asthma control.

AB - BackgroundIn children with uncontrolled asthma prescribed low-dose inhaled corticosteroids (ICSs), various step-up options are available: fixed-dose combination ICS/long-acting β2-agonist (FDC), increasing ICS dose, or adding leukotriene receptor antagonist (LTRA). However, evidence of their relative effectiveness is limited.ObjectiveTo compare the effectiveness of step-up treatment to FDC in children with asthma versus increased ICS dose, or LTRA.MethodsThis matched cohort study used UK primary-care databases to study children prescribed their first step-up treatment to FDC, increased ICS dose, or LTRA. A year of baseline data was used for matching and identifying confounders. Outcomes over the following year were examined. The primary outcome was severe exacerbation rate; secondary outcomes included overall asthma control, derived from databases (no asthma-related admissions/hospital attendances/oral corticosteroids or antibiotics prescribed with a respiratory review, and average prescribed salbutamol ≤200 μg/day).ResultsThere were 971 matched pairs in the FDC and increased ICS dose cohorts (59% males; mean age, 9.4 years) and 785 in the FDC and LTRA cohorts (60% males; mean age, 9.0 years). Exacerbation rates in the outcome year were similar between FDC and increased ICS (adjusted incidence rate ratio [95% CI], 1.09 [0.75-1.59]) and FDC and LTRA (incidence rate ratio, 1.36 [0.93-2.01]). Increased ICS and LTRA significantly reduced the odds of achieving overall asthma control, compared with FDC (odds ratios [95% CI], 0.52 [0.42-0.64] and 0.53 [0.42-0.66], respectively)—this was driven by reduced short-acting beta-agonist use.ConclusionsFDC is as effective as increased ICS or LTRA in reducing severe exacerbation rate, but more effective in achieving asthma control.

KW - asthma

KW - child

KW - inhaled cortocosteroid

KW - leukotriene receptor antagonist

KW - long-acting beta-agonist

KW - step-up therapy

U2 - 10.1016/j.jaip.2016.12.028

DO - 10.1016/j.jaip.2016.12.028

M3 - Article

VL - 5

SP - 1082

EP - 1090

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 4

ER -