Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone: A real-world observational study

David Price, Richard J. Martin, Neil Barnes, Paul Dorinsky, Elliot Israel, Nicolas Roche, Alison Chisholm, Elizabeth V. Hillyer, Linda Kemp, Amanda J. Lee, Julie von Ziegenweidt, Gene Colice

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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.
Original languageEnglish
Pages (from-to)511-518.e10
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Volume126
Issue number3
Early online date9 Aug 2010
DOIs
Publication statusPublished - Sep 2010

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HFA 134a
Beclomethasone
Observational Studies
Asthma
Population
Adrenal Cortex Hormones
Odds Ratio
Fluticasone

Keywords

  • adolescent
  • adult
  • androstadienes
  • anti-asthmatic agents
  • asthma
  • beclomethasone
  • child
  • child, preschool
  • dose-response relationship, drug
  • drug therapy, combination
  • female
  • humans
  • longitudinal studies
  • male
  • middle aged
  • practice guidelines as topic
  • retrospective studies
  • treatment outcome

Cite this

Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone : A real-world observational study. / Price, David; Martin, Richard J.; Barnes, Neil; Dorinsky, Paul; Israel, Elliot; Roche, Nicolas; Chisholm, Alison; Hillyer, Elizabeth V.; Kemp, Linda; Lee, Amanda J.; von Ziegenweidt, Julie; Colice, Gene.

In: Journal of Allergy and Clinical Immunology, Vol. 126, No. 3, 09.2010, p. 511-518.e10.

Research output: Contribution to journalArticle

Price, D, Martin, RJ, Barnes, N, Dorinsky, P, Israel, E, Roche, N, Chisholm, A, Hillyer, EV, Kemp, L, Lee, AJ, von Ziegenweidt, J & Colice, G 2010, 'Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone: A real-world observational study' Journal of Allergy and Clinical Immunology, vol. 126, no. 3, pp. 511-518.e10. https://doi.org/10.1016/j.jaci.2010.06.040
Price, David ; Martin, Richard J. ; Barnes, Neil ; Dorinsky, Paul ; Israel, Elliot ; Roche, Nicolas ; Chisholm, Alison ; Hillyer, Elizabeth V. ; Kemp, Linda ; Lee, Amanda J. ; von Ziegenweidt, Julie ; Colice, Gene. / Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone : A real-world observational study. In: Journal of Allergy and Clinical Immunology. 2010 ; Vol. 126, No. 3. pp. 511-518.e10.
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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.",
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T1 - Prescribing practices and asthma control with hydrofluoroalkane-beclomethasone and fluticasone

T2 - A real-world observational study

AU - Price, David

AU - Martin, Richard J.

AU - Barnes, Neil

AU - Dorinsky, Paul

AU - Israel, Elliot

AU - Roche, Nicolas

AU - Chisholm, Alison

AU - Hillyer, Elizabeth V.

AU - Kemp, Linda

AU - Lee, Amanda J.

AU - von Ziegenweidt, Julie

AU - Colice, Gene

N1 - Copyright (c) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

PY - 2010/9

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N2 - 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.

AB - 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.

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KW - adult

KW - androstadienes

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KW - beclomethasone

KW - child

KW - child, preschool

KW - dose-response relationship, drug

KW - drug therapy, combination

KW - female

KW - humans

KW - longitudinal studies

KW - male

KW - middle aged

KW - practice guidelines as topic

KW - retrospective studies

KW - treatment outcome

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DO - 10.1016/j.jaci.2010.06.040

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JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

SN - 0091-6749

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