US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC.
US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC.
J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1488-1496.e7. doi: 10.1016/j.jaip.2018.12.021. Epub 2019 Jan 10.
Although efficacy and safety of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/F) have been demonstrated in clinical studies, real-world comparisons of utilization have not been performed.
To compare similar patients with asthma initiating FF/VI or BUD/F on measures of adherence, persistence, and the asthma medication ratio (AMR).
This was a retrospective cohort study of commercial and Medicare Advantage with Part D enrollees initiating FF/VI or BUD/F for asthma. Adult patients (≥18 years) with at least 15-month (12-month preindex and 3-month postindex) continuous enrollment and 1 or more asthma diagnosis code were eligible for the study. Patients with a history of fixed-dose inhaled corticosteroid/long-acting β-agonist and other respiratory disorders (chronic obstructive pulmonary disease, cystic fibrosis, acute respiratory failure) in the baseline period were excluded. Propensity-score matching was used to balance cohorts on baseline characteristics. Logistic regression and Cox-proportional hazard models were used to assess differences.
A total of 9951 patients met all criteria. After propensity-score matching, 1725 patients were matched in each cohort. Subjects who initiated FF/VI had a significantly higher mean proportion of days covered (P < .001), had 86% greater odds of having a proportion of days covered value of greater than or equal to 0.80 (adjusted odds ratio, 1.86; 95% CI, 1.51-2.30), 26% lower risk of discontinuation (adjusted hazard ratio, 0.74; 95% CI, 0.69-0.79), and 36% greater odds of an AMR of greater than or equal to 0.50 (adjusted odds ratio, 1.36; 95% CI, 1.23-1.50) compared with BUD/F.
Adherence and treatment persistence were low in both cohorts; however, patients initiating once-daily FF/VI were more likely to be adherent, have an AMR of greater than or equal to 0.5, and were less likely to discontinue therapy compared with patients initiating twice-daily BUD/F (GlaxoSmithKline Study HO1617302/206482).
尽管氟替卡松维兰特罗（FF/VI）和布地奈德福莫特罗（BUD/F）的疗效和安全性已在临床研究中得到证实，但尚未对其实际应用进行比较。
比较接受 FF/VI 或 BUD/F 治疗的哮喘相似患者在依从性、持久性和哮喘药物比值（AMR）方面的差异。
这是一项回顾性队列研究，纳入了接受 FF/VI 或 BUD/F 治疗哮喘的商业保险和医疗保险优势计划（含 Part D）患者。符合研究条件的患者为年龄≥18 岁、至少有 15 个月（12 个月的基线前和 3 个月的基线后）连续参保且有 1 次或多次哮喘诊断的患者。排除了基线期内有固定剂量吸入性皮质激素/长效β-激动剂和其他呼吸系统疾病（慢性阻塞性肺疾病、囊性纤维化、急性呼吸衰竭）病史的患者。采用倾向评分匹配法对基线特征进行平衡。采用 logistic 回归和 Cox 比例风险模型评估差异。
共有 9951 例患者符合所有标准。经倾向评分匹配后，每个队列匹配了 1725 例患者。与接受 BUD/F 治疗的患者相比，接受 FF/VI 治疗的患者的平均覆盖率比例更高（P<0.001），覆盖率比例大于或等于 0.80 的可能性高 86%（调整后的优势比，1.86；95%CI，1.51-2.30），停药风险低 26%（调整后的风险比，0.74；95%CI，0.69-0.79），且 AMR 大于或等于 0.50 的可能性高 36%（调整后的优势比，1.36；95%CI，1.23-1.50）。
两个队列的依从性和治疗持久性均较低；然而，与接受每日两次 BUD/F 治疗的患者相比，接受每日一次 FF/VI 治疗的患者更有可能依从治疗、达到 AMR 大于或等于 0.5，且停药可能性更低（葛兰素史克研究 HO1617302/206482）。
