Lanz Miguel J, Pollack Michael, Gilbert Ileen A, Gandhi Hitesh N, Tkacz Joseph P, Lugogo Njira L
Allergy and Immunology Division, Nicklaus Children's Hospital, Miami, FL, USA.
BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA.
J Asthma Allergy. 2024 Sep 14;17:871-877. doi: 10.2147/JAA.S470975. eCollection 2024.
To examine patterns of short-acting ß-agonist (SABA) and maintenance therapy claims surrounding the subset of severe asthma exacerbations associated with outpatient, urgent care, or emergency department visits or hospitalization (termed serious exacerbations) in patients treated as intermittent or mild persistent asthma.
This was a retrospective study of 2010-2017 administrative claims from Merative MarketScan US databases for patients ≥12 years filling a SABA prescription for asthma (index). Patients had ≥12 months continuous insurance eligibility pre- and post-index and ≥1 additional SABA and/or maintenance medication fill appropriate for mild persistent asthma post-index. Prescription fills were assessed over 30 days before and after a serious exacerbation event.
Of 323,443 patients (mean [standard deviation] age: 34.9 [18.2] years; 62.0% female) treated as intermittent or mild persistent asthma, 51,690 (16.0%) experienced ≥1 serious exacerbation post-index. During the 30 days pre-event, a greater proportion of patients filled a SABA versus maintenance therapy (24.6% vs 19.0%; odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.35-1.43; p < 0.001); during the 30 days post-event, patients were more likely to fill maintenance medication versus SABA (88.6% vs 67.0%; OR [95% CI]: 3.88 [3.75-4.01]; p < 0.001). The closer in time prior to the event, the greater the likelihood of filling a SABA versus maintenance prescription (OR [95% CI]; 1-7 days pre-event: 1.42 [1.36-1.48]; 8-14 days pre-event: 1.34 [1.27-1.41]; 15-30 days pre-event: 1.18 [1.12-1.24]; all p < 0.001). Over 4.5 times more patients filled a maintenance therapy within 7 days post-event (45,014) versus all 30 days pre-event (9835) (OR [95% CI]: 28.7 [27.7-29.7]; p < 0.001).
These patterns of SABA rescue and maintenance fills suggest that a "window of opportunity" may exist to interrupt a serious exacerbation occurrence for patients treated as intermittent or mild persistent asthma if symptoms and inflammation are addressed concomitantly.
研究在接受间歇性或轻度持续性哮喘治疗的患者中，与门诊、紧急护理、急诊科就诊或住院相关的严重哮喘加重（称为严重加重）亚组周围的短效β-激动剂（SABA）和维持治疗索赔模式。
这是一项回顾性研究，对2010 - 2017年来自Merative MarketScan美国数据库的≥12岁哮喘患者（索引）的行政索赔进行分析，这些患者开具了SABA哮喘处方。患者在索引前后有≥12个月的连续保险资格，并且在索引后有≥1次额外的适合轻度持续性哮喘的SABA和/或维持药物填充。在严重加重事件发生前30天和后30天评估处方填充情况。
在323,443例接受间歇性或轻度持续性哮喘治疗的患者中（平均[标准差]年龄：34.9 [18.2]岁；62.0%为女性），51,690例（16.0%）在索引后经历了≥1次严重加重。在事件前30天内，填充SABA的患者比例高于维持治疗（24.6%对19.0%；优势比[OR]：1.39，95%置信区间[CI]：1.35 - 1.43；p < 0.001）；在事件后30天内，患者填充维持药物的可能性高于SABA（88.6%对67.0%；OR [95% CI]：3.88 [3.75 - 4.01]；p < 0.001）。事件发生前时间越接近，填充SABA与维持处方的可能性越大（OR [95% CI]；事件前1 - 7天：1.42 [1.36 - 1.48]；事件前8 - 14天：1.34 [1.27 - 1.41]；事件前15 - 30天：1.18 [1.12 - 1.24]；所有p < 0.001）。事件后7天内填充维持治疗的患者比事件前30天内所有患者多4.5倍以上（45,014例对9835例）（OR [95% CI]：28.7 [27.7 - 29.7]；p < 0.001）。
这些SABA急救和维持填充模式表明，如果同时处理症状和炎症，对于接受间歇性或轻度持续性哮喘治疗的患者，可能存在一个“机会窗口”来中断严重加重的发生。
