Busse William W, Fang Juanzhi, Marvel Jessica, Tian Hengfeng, Altman Pablo, Cao Hui
Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Novartis Pharmaceuticals Corporation, Global Medical Affairs, East Hanover, NJ, USA.
J Asthma. 2022 May;59(5):1051-1062. doi: 10.1080/02770903.2021.1897834. Epub 2021 Mar 31.
Despite advances in treatment, asthma remains uncontrolled in many patients, with increased risk of exacerbation and associated healthcare resource utilization (HCRU). We describe patient characteristics, exacerbations, asthma control, and HCRU using GINA treatment step (GS) as a proxy for asthma severity. .
Using a large, US, health-claims database, 4 longitudinal cohorts of 517,738 patients in GS2-5, including a subgroup of patients with baseline eosinophil (EOS) counts, were analyzed retrospectively (study period 2010 - 2016). Index for each cohort was patients' first time entering the GS, determined by first claim of first regimen. Uncontrolled asthma was defined according to published criteria as a multi-dimensional measure that includes number of exacerbations. Key variables including, baseline characteristics, post-index exacerbations, and HCRU (all-cause and asthma-specific events) are summarized by descriptive statistics.
Uncontrolled asthma was reported in 19.8% patients in GS2, 44.8% in GS3, 49.3% in GS4, and 58.6% in GS5. Annualized mean (SD) rates of exacerbation 12 months post-index generally increased across GS2-5 (0.26 [0.86], 0.32 [0.79], 0.36 [0.83], 0.29 [0.86], respectively). HCRU also increased with increasing GS, with higher HCRU among the uncontrolled cohort within each GS. In patients with EOS ≥300 cells/µL, uncontrolled asthma also increased with increasing GS (21.8%, 43.9%, 50.5%, 67.2% for GS2-5, respectively).
This large database study provides real-world evidence of the substantial degree of uncontrolled asthma in US clinical practice across GS, supporting calls for better asthma management. Healthcare burden tends to increase with lack of control in all groups, highlighting the need for improved patient education, adherence, access, and treatment optimization.
Supplemental data for this article can be accessed at publisher's website.
尽管治疗取得了进展，但许多哮喘患者的病情仍未得到控制，急性加重风险增加，医疗资源利用（HCRU）也相应增加。我们以全球哮喘防治创议（GINA）治疗步骤（GS）作为哮喘严重程度的替代指标，描述患者特征、急性加重情况、哮喘控制情况及医疗资源利用情况。
利用美国一个大型医保理赔数据库，对517,738名处于GS2-5级的患者的4个纵向队列进行回顾性分析（研究期为2010年至2016年），其中包括一个有基线嗜酸性粒细胞（EOS）计数的患者亚组。每个队列的索引为患者首次进入GS级别的时间，由首个治疗方案的首次理赔确定。根据已发表的标准，将未控制的哮喘定义为一种多维测量指标，其中包括急性加重次数。通过描述性统计总结关键变量，包括基线特征、索引后急性加重情况及医疗资源利用情况（全因性和哮喘特异性事件）。
GS2级患者中19.8%报告有未控制的哮喘，GS3级为44.8%，GS4级为49.3%，GS5级为58.6%。索引后12个月的年化平均（标准差）急性加重率在GS2-5级中总体呈上升趋势（分别为0.26 [0.86]、0.32 [0.79]、0.36 [0.83]、0.29 [0.86]）。医疗资源利用也随着GS级别的升高而增加，每个GS级别中未控制队列的医疗资源利用更高。在EOS≥300个细胞/微升的患者中，未控制的哮喘也随着GS级别的升高而增加（GS2-5级分别为21.8%、43.9%、50.5%、67.2%）。
这项大型数据库研究提供了美国临床实践中各GS级别哮喘未控制程度的真实世界证据，支持了改善哮喘管理的呼吁。在所有组中，缺乏控制往往会增加医疗负担，突出了改善患者教育、依从性、可及性和治疗优化的必要性。
本文的补充数据可在出版商网站获取。
