Department of Pulmonary Medicine, Kagoshima University, Kagoshima, Japan.
Novartis Pharma AG, Basel, Switzerland.
NPJ Prim Care Respir Med. 2021 Mar 2;31(1):12. doi: 10.1038/s41533-021-00222-2.
Many asthma patients remain uncontrolled despite guideline-based therapies. We examined real-life asthma control in Japanese patients prescribed with inhaled corticosteroid/long-acting β-agonist (ICS/LABA). Patients (≥12 years) with ≥2 asthma diagnoses, newly initiated on medium-/high-dose ICS/LABA (Japanese asthma guidelines), from 01 April 2009 to 31 March 2015 were included, using Japan Medical Data Center Claims Database. Primary objective: proportion of patients with uncontrolled asthma in the year following ICS/LABA initiation. Secondary objectives: predictors of uncontrolled asthma and healthcare resource utilization. In medium-dose (N = 24,937) and high-dose (N = 8661) ICS/LABA cohorts, 23% and 21% patients, respectively, were uncontrolled. Treatment step up and exacerbation were most common indicators of uncontrolled asthma. Predictors of uncontrolled asthma, analyzed by multivariable Cox model, included systemic corticosteroid use, exacerbation history, comorbidities, and being female. In both cohorts, healthcare resource utilization was higher in patients with uncontrolled asthma. Over 20% patients with persistent asthma who initiated medium- or high-dose ICS/LABA were uncontrolled, highlighting unmet need for novel therapies in these patients.
尽管基于指南的治疗方法已经存在，但许多哮喘患者的病情仍未得到控制。我们研究了日本接受吸入皮质类固醇/长效β激动剂（ICS/LABA）治疗的患者的现实生活中的哮喘控制情况。本研究纳入了 2009 年 4 月 1 日至 2015 年 3 月 31 日期间使用日本医疗数据中心索赔数据库、新开始接受中/高剂量 ICS/LABA（日本哮喘指南）治疗、有≥2 次哮喘诊断的≥12 岁患者。主要目标：ICS/LABA 起始后 1 年内未得到控制的哮喘患者比例。次要目标：未得到控制的哮喘的预测因素和医疗资源利用情况。在中剂量（N=24937）和高剂量（N=8661）ICS/LABA 队列中，分别有 23%和 21%的患者未得到控制。治疗升级和加重是未得到控制哮喘的最常见指标。多变量 Cox 模型分析显示，未得到控制的哮喘的预测因素包括全身皮质类固醇的使用、加重史、合并症和女性。在两个队列中，未得到控制哮喘患者的医疗资源利用率均较高。超过 20%开始接受中或高剂量 ICS/LABA 治疗的持续性哮喘患者仍未得到控制，这表明这些患者需要新型疗法。
