Comparative effectiveness of step-up therapies in children with asthma prescribed inhaled corticosteroids: a historical cohort study
Comparative effectiveness of step-up therapies in children with asthma prescribed inhaled corticosteroids: a historical cohort study
Background: in children with uncontrolled asthmaprescribed low-dose inhaled corticosteroids (ICSs), various stepupoptions are available: fixed-dose combination ICS/longactingb2-agonist (FDC), increasing ICS dose, or addingleukotriene receptor antagonist (LTRA). However, evidence oftheir relative effectiveness is limited.OBJECTIVE: To compare the effectiveness of step-up treatmentto FDC in children with asthma versus increased ICS dose, orLTRA.
Methods: this matched cohort study used UK primary-caredatabases to study children prescribed their first step-up treatmentto FDC, increased ICS dose, or LTRA. A year of baselinedata was used for matching and identifying confounders. Outcomesover the following year were examined. The primaryoutcome was severe exacerbation rate; secondary outcomesincluded overall asthma control, derived from databases (noasthma-related admissions/hospital attendances/oral corticosteroidsor antibiotics prescribed with a respiratory review, andaverage prescribed salbutamol £200 mg/day).
Results: there were 971 matched pairs in the FDC andincreased ICS dose cohorts (59% males; mean age, 9.4 years) and785 in the FDC and LTRA cohorts (60% males; mean age, 9.0years). Exacerbation rates in the outcome year were similarbetween FDC and increased ICS (adjusted incidence rate ratio[95% CI], 1.09 [0.75-1.59]) and FDC and LTRA (incidence rateratio, 1.36 [0.93-2.01]). Increased ICS and LTRA significantlyreduced the odds of achieving overall asthma control, comparedwith FDC (odds ratios [95% CI], 0.52 [0.42-0.64] and 0.53[0.42-0.66], respectively)—this was driven by reduced shortactingbeta-agonist use.
Conclusions: FDC is as effective as increased ICS or LTRAin reducing severe exacerbation rate, but more effective inachieving asthma control. 2017 American Academy ofAllergy, Asthma & Immunology (J Allergy Clin Immunol Pract2017;-:---)
1082-1090
Murray, Claire
2d1c6a8c-a5b8-4606-a9c7-ccbacdd21007
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Richardson, Kathryn
143d5158-6788-4bb3-b5c5-2c9c2acefba2
Price, David
4dee6753-83c4-4b65-aa9d-f4e915018b57
Turner, Steve
db854915-7aa0-4c38-b2f7-9ec23b1d2828
July 2017
Murray, Claire
2d1c6a8c-a5b8-4606-a9c7-ccbacdd21007
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Richardson, Kathryn
143d5158-6788-4bb3-b5c5-2c9c2acefba2
Price, David
4dee6753-83c4-4b65-aa9d-f4e915018b57
Turner, Steve
db854915-7aa0-4c38-b2f7-9ec23b1d2828
Murray, Claire, Thomas, Mike, Richardson, Kathryn, Price, David and Turner, Steve
(2017)
Comparative effectiveness of step-up therapies in children with asthma prescribed inhaled corticosteroids: a historical cohort study.
The Journal of Allergy and Clinical immunology: In Practice, 5 (4), .
(doi:10.1016/j.jaip.2016.12.028).
Abstract
Background: in children with uncontrolled asthmaprescribed low-dose inhaled corticosteroids (ICSs), various stepupoptions are available: fixed-dose combination ICS/longactingb2-agonist (FDC), increasing ICS dose, or addingleukotriene receptor antagonist (LTRA). However, evidence oftheir relative effectiveness is limited.OBJECTIVE: To compare the effectiveness of step-up treatmentto FDC in children with asthma versus increased ICS dose, orLTRA.
Methods: this matched cohort study used UK primary-caredatabases to study children prescribed their first step-up treatmentto FDC, increased ICS dose, or LTRA. A year of baselinedata was used for matching and identifying confounders. Outcomesover the following year were examined. The primaryoutcome was severe exacerbation rate; secondary outcomesincluded overall asthma control, derived from databases (noasthma-related admissions/hospital attendances/oral corticosteroidsor antibiotics prescribed with a respiratory review, andaverage prescribed salbutamol £200 mg/day).
Results: there were 971 matched pairs in the FDC andincreased ICS dose cohorts (59% males; mean age, 9.4 years) and785 in the FDC and LTRA cohorts (60% males; mean age, 9.0years). Exacerbation rates in the outcome year were similarbetween FDC and increased ICS (adjusted incidence rate ratio[95% CI], 1.09 [0.75-1.59]) and FDC and LTRA (incidence rateratio, 1.36 [0.93-2.01]). Increased ICS and LTRA significantlyreduced the odds of achieving overall asthma control, comparedwith FDC (odds ratios [95% CI], 0.52 [0.42-0.64] and 0.53[0.42-0.66], respectively)—this was driven by reduced shortactingbeta-agonist use.
Conclusions: FDC is as effective as increased ICS or LTRAin reducing severe exacerbation rate, but more effective inachieving asthma control. 2017 American Academy ofAllergy, Asthma & Immunology (J Allergy Clin Immunol Pract2017;-:---)
Text
1-s2.0-S2213219817300119-main
- Proof
Restricted to Repository staff only
Request a copy
More information
Accepted/In Press date: 29 December 2016
e-pub ahead of print date: 27 March 2017
Published date: July 2017
Identifiers
Local EPrints ID: 413538
URI: http://eprints.soton.ac.uk/id/eprint/413538
ISSN: 2213-2198
PURE UUID: 207bc84e-e227-4030-9f32-2cfdf137f8df
Catalogue record
Date deposited: 25 Aug 2017 16:31
Last modified: 15 Mar 2024 14:06
Export record
Altmetrics
Contributors
Author:
Claire Murray
Author:
Kathryn Richardson
Author:
David Price
Author:
Steve Turner
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics