Inhaled Corticosteroid-Containing Treatment Escalation and Outcomes for Patients with Asthma in a U.S. Health Care Organization

• DOI: 10.18553/jmcp.2017.23.11.1149
• Publication Date: 2017-10-30T16:49:34Z
• Authors: Lindsay G. S. Ben...; Yanni Yu; Weijia Wang; Feng Cao; Erin M. Hulbert; Ryan Wolbeck; Caitlin A. Elliott; Ami R. Buikema
• Keywords: Adult; Male; Dose-Response Relationship, Drug; Middle Aged; Patient Acceptance of Health Care; Asthma; United States; 3. Good health; Cohort Studies; Insurance Claim Review; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Adrenal Cortex Hormones; Administration, Inhalation; Humans; Female; Anti-Asthmatic Agents

Asthma is a common disorder that affects approximately 8% of the U.S.Treatment guidelines indicate inhaled corticosteroids (ICS) as mainstay treatment, yet poor asthma control among ICS-treated patients. Treatment escalation (ICS dose increase and other controller therapy add-ons) used to manage symptoms. Real-world studies postescalation outcomes may inform treatment decisions.To (a) describe characteristics patterns patients who escalated (b) assess (exacerbations, uncontrolled asthma, health care resource utilization [HCRU]) after escalation.The study cohort was identified from large U.S. administrative claims database via ICD-9-CM codes for (493.xx on ≥ 2 dates) initiation (defining index date) long-term (> 1 fill) ICS-containing between January 1, 2009, September 30, 2014. One year continuous enrollment required before date. Escalation defined following: ICS increase; switch ICS, long-acting beta-2 agonists (LABA), or leukotriene modifiers (LTRM) different LABA, LTRM; add-on medications (e.g., antibody biologic). were examined. Rates exacerbation (defined by inpatient admission, emergency department [ED] visit, office visit with pharmacy claim an oral corticosteroid [OCS] within 7 days) occurrence > 4 fills short-acting beta agonist [SABA] in 1-year period, OCS fill, asthma-related ED admission) calculated. Per-patient-per-year (PPPY) HCRU estimated.Among 35,126 (mean [SD] age 38 [16] years) initiated 5,044 (14%) their regimens at 136 (105) days post-index (i.e., pre-escalation period). The most frequent changes, alone combination, included (68%) LABA (27%) LTRM (25%) add-ons. Before escalation, rate 1.60 (5.10) PPPY, 1,108 (22%) experienced exacerbation. During period 251.6 (138.9) days, 0.75 (2.9) 1,038 (21%) A majority 85%) exacerbations periods associated plus days. Uncontrolled 41.5% 41.0% respectively. Ambulatory visits 24.0 [26.7] all-cause 8.5 [13.4] PPPY) (19.3 [21.3] 4.6 [8.1] PPPY).Among regimen, 14% initiation. Yet, 21% those had exacerbation, 41% escalation. results demonstrate unmet need treatment.This sponsored funded Boehringer-Ingelheim, which contracted Optum conduct research. sponsor collaborated preparation, writing, revision, approval manuscript. Bengston, Cao, Hulbert, Wolbeck, Elliott, Buikema are employees Optum. Yu Wang employed Boehringer-Ingelheim. Study concept design contributed Yu, Wang. Wolbeck collected data, data analysis performed manuscript written along Wang, revised authors.