Extrafine Versus Fine Inhaled Corticosteroids in Relation to Asthma Control

A Systematic Review and Meta-Analysis of Observational Real-Life Studies

Samatha Sonnappa, Brett McQueen, Dirkje S Postma, Richard J Martin, Nicolas Roche, Jonathan Grigg, Theresa Guilbert, Caroline Gouder, Emilio Pizzichini, Akio Niimi, Wanda Phipatanakul, Alison Chisholm, Ronald J Dandurand, Alan Kaplan, Elliot Israel, Alberto Papi, Willem M C van Aalderen, Omar S Usmani, David B Price

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The particle size of inhaled corticosteroids (ICSs) may affect airway drug deposition and effectiveness.

OBJECTIVE: To compare the effectiveness of extrafine ICSs (mass median aerodynamic diameter, <2 μm) versus fine-particle ICSs administered as ICS monotherapy or ICS-long-acting β-agonist combination therapy by conducting a meta-analysis of observational real-life asthma studies to estimate the treatment effect of extrafine ICSs.

METHODS: MEDLINE and EMBASE databases were reviewed for asthma observational comparative effectiveness studies from January 2004 to June 2016. Studies were included if they reported odds and relative risk ratios and met all inclusion criteria (Respiratory Effectiveness Group/European Academy of Allergy and Clinical Immunology quality standards, comparison of extrafine ICSs with same or different ICS molecule, ≥12-month follow-up). End-point data (asthma control, exacerbations, prescribed ICS dose) were pooled. Random-effects meta-analysis modeling was used. The study protocol is published in the PROSPERO register CRD42016039137.

RESULTS: Seven studies with 33,453 subjects aged 5 to 80 years met eligibility criteria for inclusion. Six studies used extrafine beclometasone propionate and 1 study used both extrafine beclometasone propionate and extrafine ciclesonide as comparators with fine-particle ICSs. The overall odds of achieving asthma control were significantly higher for extrafine ICSs compared with fine-particle ICSs (odds ratio, 1.34; 95% CI, 1.22-1.46). Overall exacerbation rate ratios (0.84; 95% CI, 0.73-0.97) and ICS dose (weighted mean difference, -170 μg; 95% CI, -222 to -118 μg) were significantly lower for extrafine ICSs compared with fine-particle ICSs.

CONCLUSIONS: This meta-analysis demonstrates that extrafine ICSs have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower prescribed doses than fine-particle ICSs.

Original languageEnglish
Pages (from-to)907-915.e7
Number of pages16
JournalThe journal of allergy and clinical immunology. In practice
Volume6
Issue number3
Early online date20 Sep 2017
DOIs
Publication statusPublished - 30 May 2018

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Meta-Analysis
Adrenal Cortex Hormones
Asthma
Beclomethasone
Propionates
Odds Ratio
Allergy and Immunology
Particle Size
MEDLINE

Keywords

  • Journal Article
  • asthma control
  • Conventional ICS
  • Extrafine beclometasone dipropionate
  • Extrafine ciclesonide
  • Extrafine-particle ICS
  • Fine-particle ICS
  • Inhaled corticosteroids
  • Observational studies
  • Real-life

Cite this

Extrafine Versus Fine Inhaled Corticosteroids in Relation to Asthma Control : A Systematic Review and Meta-Analysis of Observational Real-Life Studies. / Sonnappa, Samatha; McQueen, Brett; Postma, Dirkje S; Martin, Richard J; Roche, Nicolas; Grigg, Jonathan; Guilbert, Theresa; Gouder, Caroline; Pizzichini, Emilio; Niimi, Akio; Phipatanakul, Wanda; Chisholm, Alison; Dandurand, Ronald J; Kaplan, Alan; Israel, Elliot; Papi, Alberto; van Aalderen, Willem M C; Usmani, Omar S; Price, David B.

In: The journal of allergy and clinical immunology. In practice, Vol. 6, No. 3, 30.05.2018, p. 907-915.e7.

Research output: Contribution to journalArticle

Sonnappa, S, McQueen, B, Postma, DS, Martin, RJ, Roche, N, Grigg, J, Guilbert, T, Gouder, C, Pizzichini, E, Niimi, A, Phipatanakul, W, Chisholm, A, Dandurand, RJ, Kaplan, A, Israel, E, Papi, A, van Aalderen, WMC, Usmani, OS & Price, DB 2018, 'Extrafine Versus Fine Inhaled Corticosteroids in Relation to Asthma Control: A Systematic Review and Meta-Analysis of Observational Real-Life Studies', The journal of allergy and clinical immunology. In practice, vol. 6, no. 3, pp. 907-915.e7. https://doi.org/10.1016/j.jaip.2017.07.032
Sonnappa, Samatha ; McQueen, Brett ; Postma, Dirkje S ; Martin, Richard J ; Roche, Nicolas ; Grigg, Jonathan ; Guilbert, Theresa ; Gouder, Caroline ; Pizzichini, Emilio ; Niimi, Akio ; Phipatanakul, Wanda ; Chisholm, Alison ; Dandurand, Ronald J ; Kaplan, Alan ; Israel, Elliot ; Papi, Alberto ; van Aalderen, Willem M C ; Usmani, Omar S ; Price, David B. / Extrafine Versus Fine Inhaled Corticosteroids in Relation to Asthma Control : A Systematic Review and Meta-Analysis of Observational Real-Life Studies. In: The journal of allergy and clinical immunology. In practice. 2018 ; Vol. 6, No. 3. pp. 907-915.e7.
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abstract = "BACKGROUND: The particle size of inhaled corticosteroids (ICSs) may affect airway drug deposition and effectiveness.OBJECTIVE: To compare the effectiveness of extrafine ICSs (mass median aerodynamic diameter, <2 μm) versus fine-particle ICSs administered as ICS monotherapy or ICS-long-acting β-agonist combination therapy by conducting a meta-analysis of observational real-life asthma studies to estimate the treatment effect of extrafine ICSs.METHODS: MEDLINE and EMBASE databases were reviewed for asthma observational comparative effectiveness studies from January 2004 to June 2016. Studies were included if they reported odds and relative risk ratios and met all inclusion criteria (Respiratory Effectiveness Group/European Academy of Allergy and Clinical Immunology quality standards, comparison of extrafine ICSs with same or different ICS molecule, ≥12-month follow-up). End-point data (asthma control, exacerbations, prescribed ICS dose) were pooled. Random-effects meta-analysis modeling was used. The study protocol is published in the PROSPERO register CRD42016039137.RESULTS: Seven studies with 33,453 subjects aged 5 to 80 years met eligibility criteria for inclusion. Six studies used extrafine beclometasone propionate and 1 study used both extrafine beclometasone propionate and extrafine ciclesonide as comparators with fine-particle ICSs. The overall odds of achieving asthma control were significantly higher for extrafine ICSs compared with fine-particle ICSs (odds ratio, 1.34; 95{\%} CI, 1.22-1.46). Overall exacerbation rate ratios (0.84; 95{\%} CI, 0.73-0.97) and ICS dose (weighted mean difference, -170 μg; 95{\%} CI, -222 to -118 μg) were significantly lower for extrafine ICSs compared with fine-particle ICSs.CONCLUSIONS: This meta-analysis demonstrates that extrafine ICSs have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower prescribed doses than fine-particle ICSs.",
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note = "This systematic review and meta-analysis was jointly supported by Respiratory Effectiveness Ltd, the Observational and Pragmatic Research Institute Pte Ltd, and Chiesi Farmaceutici SpA on behalf of the Respiratory Effectiveness Group's Small Airways Working Group.",
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T1 - Extrafine Versus Fine Inhaled Corticosteroids in Relation to Asthma Control

T2 - A Systematic Review and Meta-Analysis of Observational Real-Life Studies

AU - Sonnappa, Samatha

AU - McQueen, Brett

AU - Postma, Dirkje S

AU - Martin, Richard J

AU - Roche, Nicolas

AU - Grigg, Jonathan

AU - Guilbert, Theresa

AU - Gouder, Caroline

AU - Pizzichini, Emilio

AU - Niimi, Akio

AU - Phipatanakul, Wanda

AU - Chisholm, Alison

AU - Dandurand, Ronald J

AU - Kaplan, Alan

AU - Israel, Elliot

AU - Papi, Alberto

AU - van Aalderen, Willem M C

AU - Usmani, Omar S

AU - Price, David B

N1 - This systematic review and meta-analysis was jointly supported by Respiratory Effectiveness Ltd, the Observational and Pragmatic Research Institute Pte Ltd, and Chiesi Farmaceutici SpA on behalf of the Respiratory Effectiveness Group's Small Airways Working Group.

PY - 2018/5/30

Y1 - 2018/5/30

N2 - BACKGROUND: The particle size of inhaled corticosteroids (ICSs) may affect airway drug deposition and effectiveness.OBJECTIVE: To compare the effectiveness of extrafine ICSs (mass median aerodynamic diameter, <2 μm) versus fine-particle ICSs administered as ICS monotherapy or ICS-long-acting β-agonist combination therapy by conducting a meta-analysis of observational real-life asthma studies to estimate the treatment effect of extrafine ICSs.METHODS: MEDLINE and EMBASE databases were reviewed for asthma observational comparative effectiveness studies from January 2004 to June 2016. Studies were included if they reported odds and relative risk ratios and met all inclusion criteria (Respiratory Effectiveness Group/European Academy of Allergy and Clinical Immunology quality standards, comparison of extrafine ICSs with same or different ICS molecule, ≥12-month follow-up). End-point data (asthma control, exacerbations, prescribed ICS dose) were pooled. Random-effects meta-analysis modeling was used. The study protocol is published in the PROSPERO register CRD42016039137.RESULTS: Seven studies with 33,453 subjects aged 5 to 80 years met eligibility criteria for inclusion. Six studies used extrafine beclometasone propionate and 1 study used both extrafine beclometasone propionate and extrafine ciclesonide as comparators with fine-particle ICSs. The overall odds of achieving asthma control were significantly higher for extrafine ICSs compared with fine-particle ICSs (odds ratio, 1.34; 95% CI, 1.22-1.46). Overall exacerbation rate ratios (0.84; 95% CI, 0.73-0.97) and ICS dose (weighted mean difference, -170 μg; 95% CI, -222 to -118 μg) were significantly lower for extrafine ICSs compared with fine-particle ICSs.CONCLUSIONS: This meta-analysis demonstrates that extrafine ICSs have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower prescribed doses than fine-particle ICSs.

AB - BACKGROUND: The particle size of inhaled corticosteroids (ICSs) may affect airway drug deposition and effectiveness.OBJECTIVE: To compare the effectiveness of extrafine ICSs (mass median aerodynamic diameter, <2 μm) versus fine-particle ICSs administered as ICS monotherapy or ICS-long-acting β-agonist combination therapy by conducting a meta-analysis of observational real-life asthma studies to estimate the treatment effect of extrafine ICSs.METHODS: MEDLINE and EMBASE databases were reviewed for asthma observational comparative effectiveness studies from January 2004 to June 2016. Studies were included if they reported odds and relative risk ratios and met all inclusion criteria (Respiratory Effectiveness Group/European Academy of Allergy and Clinical Immunology quality standards, comparison of extrafine ICSs with same or different ICS molecule, ≥12-month follow-up). End-point data (asthma control, exacerbations, prescribed ICS dose) were pooled. Random-effects meta-analysis modeling was used. The study protocol is published in the PROSPERO register CRD42016039137.RESULTS: Seven studies with 33,453 subjects aged 5 to 80 years met eligibility criteria for inclusion. Six studies used extrafine beclometasone propionate and 1 study used both extrafine beclometasone propionate and extrafine ciclesonide as comparators with fine-particle ICSs. The overall odds of achieving asthma control were significantly higher for extrafine ICSs compared with fine-particle ICSs (odds ratio, 1.34; 95% CI, 1.22-1.46). Overall exacerbation rate ratios (0.84; 95% CI, 0.73-0.97) and ICS dose (weighted mean difference, -170 μg; 95% CI, -222 to -118 μg) were significantly lower for extrafine ICSs compared with fine-particle ICSs.CONCLUSIONS: This meta-analysis demonstrates that extrafine ICSs have significantly higher odds of achieving asthma control with lower exacerbation rates at significantly lower prescribed doses than fine-particle ICSs.

KW - Journal Article

KW - asthma control

KW - Conventional ICS

KW - Extrafine beclometasone dipropionate

KW - Extrafine ciclesonide

KW - Extrafine-particle ICS

KW - Fine-particle ICS

KW - Inhaled corticosteroids

KW - Observational studies

KW - Real-life

U2 - 10.1016/j.jaip.2017.07.032

DO - 10.1016/j.jaip.2017.07.032

M3 - Article

VL - 6

SP - 907-915.e7

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

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

SN - 2213-2198

IS - 3

ER -