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奥马珠单抗治疗的一致性与哮喘控制的关系。

Association between consistent omalizumab treatment and asthma control.

机构信息

Groupe d'analyse, Ltée, Montréal, Québec, Canada.

出版信息

J Allergy Clin Immunol Pract. 2013 Jan;1(1):51-7. doi: 10.1016/j.jaip.2012.08.006. Epub 2012 Oct 28.

Abstract

BACKGROUND

Omalizumab is indicated for patients with moderate-to-severe allergic asthma with inadequately controlled symptoms.

OBJECTIVE

We evaluated the association between consistent omalizumab treatment and asthma control.

METHODS

Health insurance claims from the MarketScan database (2002Q1-2011Q2) were analyzed. Asthmatic patients with ≥12 months of continuous insurance coverage after the first omalizumab claim (index date) after 6 months of continuous omalizumab use were included. A 12-month landmark period was used to assess treatment consistency, defined as uninterrupted treatment without a gap of ≥28 days in omalizumab use. The effect of consistent omalizumab treatment on asthma control between months 13 and 24 was evaluated. Multivariate time-varying Cox regressions were also conducted to assess the adjusted effect of treatment interruption on asthma control from month 1 to month 24.

RESULTS

A total of 3044 patients (mean age, 48.5 years; female, 62%) formed the study population. Patients consistent with omalizumab treatment at 12 months (39% of patients) were less likely to have an uncontrolled asthma event during months 13 to 24 with only 49% of patients experiencing one event compared with 54% in the non consistent subgroup (P = .02). In addition, consistent omalizumab treatment at 12 months was associated with a 51% reduction in the mean number of asthma-related emergency department (ED) visits per patient and a 28% reduction in asthma-related hospitalizations. Multivariate analyses corroborated these findings (hazard ratio for consistent vs non-consistent: risk of short-acting β2-agonists prescription, oral corticosteroids prescription, ED visit, or hospitalization, 0.76; 95% CI, 0.69-0.83]).

CONCLUSION

This analysis showed that consistent omalizumab treatment was associated with significant reductions in ED visits and hospitalizations.

摘要

背景

奥马珠单抗适用于症状控制不佳的中重度过敏性哮喘患者。

目的

我们评估了奥马珠单抗治疗的一致性与哮喘控制之间的关联。

方法

分析了 MarketScan 数据库(2002Q1-2011Q2)的健康保险索赔数据。纳入在使用奥马珠单抗 6 个月后,首次奥马珠单抗用药后至少 12 个月连续保险覆盖的哮喘患者(索引日期)。使用 12 个月的时间点来评估治疗的一致性,定义为奥马珠单抗使用过程中无≥28 天的中断。评估第 13 至 24 个月时,持续奥马珠单抗治疗对哮喘控制的影响。还进行了多变量时变 Cox 回归分析,以评估从第 1 个月到第 24 个月治疗中断对哮喘控制的调整影响。

结果

共有 3044 名患者(平均年龄 48.5 岁,女性占 62%)构成了研究人群。在第 12 个月时符合奥马珠单抗治疗标准的患者(39%的患者)在第 13 至 24 个月时发生未控制的哮喘事件的可能性较小,只有 49%的患者发生 1 次事件,而非一致性亚组的这一比例为 54%(P =.02)。此外,在第 12 个月时持续奥马珠单抗治疗与每位患者哮喘相关急诊就诊次数平均减少 51%和哮喘相关住院治疗减少 28%相关。多变量分析证实了这些发现(一致性与非一致性的危害比:短效β2-受体激动剂处方、口服皮质类固醇处方、急诊就诊或住院治疗的风险,0.76;95%CI,0.69-0.83)。

结论

这项分析表明,持续奥马珠单抗治疗与急诊就诊和住院治疗次数的显著减少相关。

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