Shoair Osama A, Cook Elizabeth A, Shipman Denver, Dunn Rebecca L
Department of Pharmaceutical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas.
Department of Clinical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas.
Pharmacotherapy. 2020 Apr;40(4):320-330. doi: 10.1002/phar.2374. Epub 2020 Mar 10.
Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are prevalent in patients with asthma. These disorders may increase asthma severity and decrease asthma control. No studies have evaluated the impact of achieving antidepressant target dose optimization compared with not achieving antidepressant target doses on asthma control in uninsured and underinsured patients.
To evaluate the impact of achieving antidepressant target dose optimization in uninsured and underinsured adult asthma patients with GAD and/or MDD on the risk of severe asthma exacerbations and number of asthma-related outcomes.
We conducted a retrospective cohort study of uninsured and underinsured adult asthma patients with GAD and/or MDD who have been initiated on a single antidepressant and maintained on a stable dose for 8 weeks (index date). Eligible patients were followed for 12-24 months after the index date and separated into those who achieved a target dose (target group) and those who did not (control group). Poisson regression was used to compare the risk of severe exacerbations, and analysis of covariance was used to compare the number of severe exacerbations and other asthma-related outcomes between the target and control groups during the 1- and 2-year post-index periods.
A total of 61 patients (24 in the target group and 37 in the control group) met inclusion criteria. The target group had a reduced risk of severe asthma exacerbations compared with the control group during the 1-year post-index (adjusted risk reduction [RR] 0.46, 95% confidence interval [CI] 0.26-0.82) and 2-year post-index (adjusted RR 0.5, 95% CI 0.3-0.82) periods. The target group also experienced a lower number of severe asthma exacerbations and other asthma-related outcomes during the 1- and 2-year post-index periods compared with the control group after adjusting for confounders.
Among uninsured and underinsured asthma patients with GAD and/or MDD who were initiated on a single antidepressant, those who were titrated to achieve target doses had a reduced risk of severe asthma exacerbations and a lower number of asthma-related outcomes than those who were not optimized to achieve target doses.
广泛性焦虑障碍（GAD）和重度抑郁症（MDD）在哮喘患者中很常见。这些疾病可能会增加哮喘的严重程度并降低哮喘控制水平。尚无研究评估在未参保和参保不足的患者中，实现抗抑郁药目标剂量优化与未达到抗抑郁药目标剂量相比对哮喘控制的影响。
评估在患有GAD和/或MDD的未参保和参保不足的成年哮喘患者中，实现抗抑郁药目标剂量优化对严重哮喘加重风险和哮喘相关结局数量的影响。
我们对患有GAD和/或MDD的未参保和参保不足的成年哮喘患者进行了一项回顾性队列研究，这些患者开始使用单一抗抑郁药并维持稳定剂量8周（索引日期）。符合条件的患者在索引日期后随访12 - 24个月，并分为达到目标剂量的患者（目标组）和未达到目标剂量的患者（对照组）。使用泊松回归比较严重加重的风险，并使用协方差分析比较目标组和对照组在索引后1年和2年期间严重加重的次数以及其他哮喘相关结局。
共有61例患者（目标组24例，对照组37例）符合纳入标准。在索引后1年（调整后的风险降低[RR] 0.46，95%置信区间[CI] 0.26 - 0.82）和索引后2年（调整后的RR 0.5，95% CI 0.3 - 0.82）期间，目标组与对照组相比，严重哮喘加重的风险降低。在调整混杂因素后，目标组在索引后1年和2年期间严重哮喘加重的次数以及其他哮喘相关结局也低于对照组。
在开始使用单一抗抑郁药的患有GAD和/或MDD的未参保和参保不足的哮喘患者中，那些滴定至目标剂量的患者与未优化至目标剂量的患者相比，严重哮喘加重的风险降低，哮喘相关结局的数量也更少。
