Stoloff Stuart W, Stempel David A, Meyer Jay, Stanford Richard H, Carranza Rosenzweig Jacqueline R
University of Nevada School of Medicine, Reno, Nev, USA.
J Allergy Clin Immunol. 2004 Feb;113(2):245-51. doi: 10.1016/j.jaci.2003.10.011.
Improved adherence to inhaled corticosteroids (ICSs) has also been associated with decreased asthma-associated morbidity and mortality.
The purpose of this study was to assess patient medication refill persistence with fluticasone propionate (FP) and salmeterol combination in a single inhaler (FSC), FP and salmeterol in combination from 2 separate inhalers, FP and montelukast in combination, FP as monotherapy, and montelukast as monotherapy.
We performed a retrospective, observational, 24-month (12-month baseline and 12-month follow-up) database study using medical and pharmacy claims from a large managed care organization. We identified 2511 subjects 12 years of age or older with a claim for asthma (International Classification of Diseases, Ninth Revision: 493.XX): 563 patients receiving FSC, 224 receiving FP plus salmeterol, 75 receiving FP plus montelukast, 798 receiving FP only, and 776 receiving montelukast only. Refill rates of FP, as a measure of adherence, were compared for each FP-containing cohort during the 12-month follow-up period. In addition, refill rates were compared between FSC, an inhaler, and montelukast, an oral medication.
Twelve-month baseline asthma medication use and patient demographics were comparable among cohorts. Patients in the FSC cohort obtained significantly more refills compared with the number of FP refills in the other FP-containing cohorts (4.06 for FSC vs 2.35 for FP plus salmeterol, 1.83 for FP plus montelukast, and 2.27 for FP alone) over the 12-month follow-up period. In addition, patients taking FSC had similar refill persistence compared with patients taking the oral leukotriene modifier montelukast (4.51).
FSC might increase ICS refill persistence compared with FP alone in a single inhaler, FP in combination with salmeterol from 2 separate inhalers, and FP in combination with montelukast. In addition, FSC in a dry powdered inhaler had similar refill rates compared with an oral asthma agent, montelukast. Use of a single inhaler containing both an ICS (FP) and a long-acting bronchodilator (salmeterol) might increase the likelihood that patients are getting more optimal ICS therapy, as well as the benefits from the long-acting bronchodilator, with patient adherence comparable to an oral agent.
吸入性糖皮质激素（ICS）依从性的提高也与哮喘相关发病率和死亡率的降低有关。
本研究的目的是评估患者使用丙酸氟替卡松（FP）与沙美特罗联合在单一吸入器（FSC）、FP与沙美特罗分别来自两个单独吸入器联合使用、FP与孟鲁司特联合使用、FP单药治疗以及孟鲁司特单药治疗时的药物再填充持续性。
我们使用来自一个大型管理式医疗组织的医疗和药房理赔数据进行了一项回顾性、观察性、为期24个月（12个月基线期和12个月随访期）的数据库研究。我们确定了2511名12岁及以上有哮喘理赔记录（国际疾病分类第九版：493.XX）的受试者：563例接受FSC治疗，224例接受FP加沙美特罗治疗，75例接受FP加孟鲁司特治疗，798例仅接受FP治疗，776例仅接受孟鲁司特治疗。在12个月随访期内，比较每个含FP队列中作为依从性衡量指标的FP再填充率。此外，还比较了FSC（一种吸入器）和孟鲁司特（一种口服药物）之间的再填充率。
各队列之间12个月基线期哮喘药物使用情况和患者人口统计学特征具有可比性。在12个月随访期内，FSC队列中的患者获得的再填充次数明显多于其他含FP队列中的FP再填充次数（FSC为4.06次，FP加沙美特罗为2.35次，FP加孟鲁司特为1.83次，FP单药治疗为2.27次）。此外，使用FSC的患者与使用口服白三烯调节剂孟鲁司特的患者具有相似的再填充持续性（4.51次）。
与单一吸入器中的FP单药治疗、来自两个单独吸入器的FP与沙美特罗联合治疗以及FP与孟鲁司特联合治疗相比，FSC可能会提高ICS的再填充持续性。此外，干粉吸入器中的FSC与口服哮喘药物孟鲁司特的再填充率相似。使用一种同时含有ICS（FP）和长效支气管扩张剂（沙美特罗）的单一吸入器可能会增加患者获得更优化ICS治疗的可能性，以及从长效支气管扩张剂中获益的可能性，且患者依从性与口服药物相当。
