Laforest Laurent, Licaj Idlir, Devouassoux Gilles, Chatté Gérard, Belhassen Manon, Van Ganse Eric, Chamba Geneviève
Lyon Pharmaco-Epidemiology Unit, UMR 5558 CNRS, Claude Bernard, Lyon 1 University, Lyon, France.
Pharmacoepidemiol Drug Saf. 2014 Sep;23(9):958-64. doi: 10.1002/pds.3668. Epub 2014 Jun 19.
"Controllers-to-total asthma drug" ratios computed from claims data identify asthmatics at risk of exacerbations. Direct link of ratios to data obtained from patients, such as control and recent outcomes, would facilitate their interpretation. We studied the relationship between R1 ratio (inhaled corticosteroids (ICS)/total anti-asthma drug ratio) and the Asthma Control Test. Comparisons were also conducted for secondary outcomes (asthma-related hospital contacts, monthly medical contacts, use of oral corticosteroids, and perception of disease burden). Results with R1 ratio were compared with those obtained with a second ratio, "ICS-plus-leukotriene receptor antagonist/total asthma drug" (R2 = ICS + leukotriene receptor antagonist/total anti-asthma drugs).
A survey was conducted in community pharmacies. Patients visiting with a prescription of anti-asthma drug and ≥12 months of drug dispensing recorded in the pharmacy were consecutively recruited. Dispensing data were linked to patient-reported outcomes. Asthma control and secondary outcomes were compared for both ratios between low-controller-ratio (R < 50%) and high-controller-ratio groups (R ≥ 50%), after excluding null values.
Of the 919 eligible patients (mean age 37 years, 55% women), 90.2% and 92.4% had non-null values for R1 and R2, respectively. Compared with the low-controller-ratio groups, adjusted risks of being uncontrolled were significantly lower in the high-controller-ratio groups (RR = 0.64, 95%CI [0.54, 0.77] and RR = 0.57, 95%CI [0.47, 0.70], for R1 and R2 ratios, respectively). Likewise, fewer patients with secondary outcomes were observed in the high-controller-ratio groups, for both ratios.
Asthma was better controlled among patients with high controller ratios, along with fewer asthma-related outcomes, for both R1 and R2 ratios. This confirms the utility of asthma/drug ratios in identifying patients at risk of exacerbations, notably in claims data.
根据索赔数据计算的“控制药物占哮喘总用药量”的比例可识别有病情加重风险的哮喘患者。将这些比例与从患者获得的数据（如控制情况和近期结果）直接关联起来，将有助于对其进行解读。我们研究了R1比例（吸入性糖皮质激素（ICS）/哮喘总用药量比例）与哮喘控制测试之间的关系。还对次要结果（与哮喘相关的医院就诊、每月医疗就诊、口服糖皮质激素的使用以及疾病负担感知）进行了比较。将R1比例的结果与通过第二个比例“ICS加白三烯受体拮抗剂/哮喘总用药量”（R2 = ICS + 白三烯受体拮抗剂/哮喘总用药量）获得的结果进行了比较。
在社区药房进行了一项调查。连续招募前来开具哮喘药物处方且药房中有≥12个月药物配药记录的患者。将配药数据与患者报告的结果相关联。在排除无效值后，比较了低控制比例组（R < 50%）和高控制比例组（R≥50%）中两种比例的哮喘控制情况和次要结果。
在919名符合条件的患者（平均年龄37岁，55%为女性）中，分别有90.2%和92.4%的患者R1和R2值不为空。与低控制比例组相比，高控制比例组中哮喘未得到控制的调整后风险显著更低（R1和R2比例的相对风险分别为RR = 0.64，95%置信区间[0.54, 0.77]和RR = 0.57，95%置信区间[0.47, 0.70]）。同样，两种比例下，高控制比例组中出现次要结果的患者也更少。
对于R1和R2比例而言，控制比例高的患者哮喘控制情况更好，且与哮喘相关的结果更少。这证实了哮喘/药物比例在识别有病情加重风险的患者方面的实用性，尤其是在索赔数据中。
