GSK, Research Triangle Park, 1600 Ala Moana Blvd, #2406, Honolulu, HI 96815, NC, USA.
Groupe d'analyses, Ltée, Montréal, QC, Canada.
Ther Adv Respir Dis. 2022 Jan-Dec;16:17534666221116997. doi: 10.1177/17534666221116997.
Suboptimal adherence to maintenance medication has been associated with poor outcomes in asthma. This study examined single-inhaler inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) adherence and asthma-related outcomes.
This retrospective observational study of patients with asthma initiating ICS/LABA used data from IQVIA PharMetrics Plus (1 January 2014-31 March 2019). Patients included were ⩾18 years old and had ⩾12 months continuous eligibility before, and ⩾180 days follow-up after, the index date. Adherence was measured as proportion of days covered ([PDC] adherent ⩾ 0.8; non-adherent <0.8) each quarter, with outcomes measured each subsequent quarter. Endpoints were asthma-related overall and severe (inpatient/emergency department [ED] visit) exacerbations, rescue medication use, and asthma-related healthcare resource utilization and costs. Regression models evaluated associations between adherence and outcomes, controlling for repeated measures and differences in baseline characteristics.
Overall, 50,037 patients were included (mean age 45.3 years; mean follow-up 23.3 months). Adherent patients were less likely to experience asthma-related overall (adjusted odds ratio [aOR] 95% confidence interval [CI]: 0.942 [0.890, 0.998]; = 0.041), or severe exacerbations (aOR [95% CI]: 0.778 [0.691, 0.877]; < 0.001) per quarter non-adherent patients. Adherent patients had lower severe exacerbation rates (adjusted rate ratio [aRR] [95% CI]: 0.792 [0.702, 0.893]; < 0.001) but similar overall exacerbation rates (aRR [95% CI]: 0.993 [0.945, 1.044]; = 0.783) non-adherent patients. The odds of rescue medication use were lower per 20% PDC increase (aOR [95% CI] short-acting β2 agonist: 0.991 [0.985, 0.996]; = 0.001; oral corticosteroid: 0.988 [0.982, 0.995]; < 0.001). Adherent patients were less likely to visit EDs per quarter (aOR [95% CI]: 0.775 [0.680, 0.883]; < 0.001) and odds of hospitalization were lower per 20% PDC increase (aOR [95% CI]: 0.930 [0.881, 0.982]; = 0.009). Across most measures, adherent patients incurred lower costs.
This real-world study highlights the short-term clinical and economic benefits of ICS/LABA adherence in asthma, particularly in reducing severe exacerbations.
维持药物治疗的依从性差与哮喘的预后不良有关。本研究考察了单吸入器吸入性皮质类固醇（ICS）/长效β2 激动剂（LABA）的依从性与哮喘相关结局。
这项回顾性观察性研究纳入了起始 ICS/LABA 的哮喘患者，数据来自 IQVIA PharMetrics Plus（2014 年 1 月 1 日至 2019 年 3 月 31 日）。纳入的患者年龄 ⩾18 岁，在索引日期前至少有 12 个月连续合格期和 ⩾180 天的随访期。依从性以每季度的覆盖天数比例（[PDC]依从性 ⩾0.8；不依从性 <0.8）来衡量，随后每季度测量结局。终点是哮喘相关的总体和严重（住院/急诊就诊）加重、抢救药物使用以及哮喘相关的医疗资源利用和成本。回归模型评估了依从性与结局之间的关联，同时控制了重复测量和基线特征的差异。
总体而言，纳入了 50037 名患者（平均年龄 45.3 岁；平均随访 23.3 个月）。与不依从的患者相比，依从的患者每季度发生哮喘相关总体（校正优势比[95%置信区间]：0.942 [0.890, 0.998]； = 0.041）或严重加重（校正优势比[95%置信区间]：0.778 [0.691, 0.877]； < 0.001）的可能性较低。依从的患者严重加重发生率较低（校正发生率比[aRR] [95% CI]：0.792 [0.702, 0.893]； < 0.001），但总体加重发生率相似（aRR [95% CI]：0.993 [0.945, 1.044]； = 0.783）。依从的患者每增加 20%PDC，使用抢救药物的可能性就会降低（短效β2 激动剂：aOR [95% CI]：0.991 [0.985, 0.996]； = 0.001；口服皮质类固醇：aOR [95% CI]：0.988 [0.982, 0.995]； < 0.001）。依从的患者每季度去急诊就诊的可能性较低（aOR [95% CI]：0.775 [0.680, 0.883]； < 0.001），每增加 20%PDC，住院的可能性也较低（aOR [95% CI]：0.930 [0.881, 0.982]； = 0.009）。在大多数指标中，依从的患者的成本较低。
这项真实世界的研究强调了 ICS/LABA 依从性在哮喘中的短期临床和经济效益，特别是在减少严重加重方面。
