Trajectory Analyses of Adherence Patterns in a Real-Life Moderate to Severe Asthma Population.

Administration, Inhalation Adrenal Cortex Hormones / therapeutic use Adrenergic beta-2 Receptor Agonists / therapeutic use Asthma / drug therapy Australia / epidemiology Drug Therapy, Combination Humans Muscarinic Antagonists / therapeutic use
Asthma Biologics Compliance Guidelines Inhaler Medication adherence Oral corticosteroids Persistence Pharmacoepidemiology

Journal

The journal of allergy and clinical immunology. In practice
ISSN: 2213-2201
Titre abrégé: J Allergy Clin Immunol Pract
Pays: United States
ID NLM: 101597220

Informations de publication

Date de publication:
06 2020
Historique:
received: 21 09 2019
revised: 04 11 2019
accepted: 04 12 2019
pubmed: 21 12 2019
medline: 15 5 2021
entrez: 21 12 2019
Statut: ppublish

Résumé

Global Initiative for Asthma step 5 therapies (GINA-5), other than inhaled corticosteroids and long-acting β-agonists in fixed dose combinations (ICS/LABA FDC), often entail more expensive (eg, monoclonal biologics) or less safe (eg, maintenance oral corticosteroids [OCS]) treatments. It is therefore important to assess poor inhaler adherence as a possible cause of suboptimal response to ICS/LABA FDC before additional GINA-5. To determine rates of, and time to, additional GINA-5 after first-year ICS/LABA FDC use, and their association with inhaler adherence. Patients initiating ICS/LABA FDC between 2013 and 2017 were identified from Australian national dispensing data. Group-based trajectory modeling was used to estimate medication adherence patterns. Multivariable Cox proportional hazards models were used to examine the association between adherence trajectories and GINA-5 addition during 2-year follow-up. In total, 3062 new ICS/LABA FDC users were identified, of whom 120 (3.9%) received additional GINA-5 (OCS: 89; long-acting muscarinic antagonists: 39; biologics: <3). Mean time to commencing additional GINA-5 was 705.2 (standard deviation, 1.7) days. Adherence trajectories were nonpersistent use (20%), seasonal use (8%), poor adherence (58%), and good adherence (13%). Although poor adherence was associated with longer time to additional GINA-5 (adjusted hazard ratio: 0.58; 95% confidence interval: 0.35-0.95), over 80% of additional GINA-5 was commenced in poorly adherent patients. Use of ≥2 OCS/antibiotic courses also predicted additional GINA-5. Almost 1 in 20 people with asthma commenced additional GINA-5 after ICS/LABA initiation, most of whom (>80%) were poorly adherent to inhaled preventers. There is a substantial unmet need for inhaler adherence to be addressed before prescribing additional GINA-5.

Sections du résumé

BACKGROUND
Global Initiative for Asthma step 5 therapies (GINA-5), other than inhaled corticosteroids and long-acting β-agonists in fixed dose combinations (ICS/LABA FDC), often entail more expensive (eg, monoclonal biologics) or less safe (eg, maintenance oral corticosteroids [OCS]) treatments. It is therefore important to assess poor inhaler adherence as a possible cause of suboptimal response to ICS/LABA FDC before additional GINA-5.
OBJECTIVE
To determine rates of, and time to, additional GINA-5 after first-year ICS/LABA FDC use, and their association with inhaler adherence.
METHODS
Patients initiating ICS/LABA FDC between 2013 and 2017 were identified from Australian national dispensing data. Group-based trajectory modeling was used to estimate medication adherence patterns. Multivariable Cox proportional hazards models were used to examine the association between adherence trajectories and GINA-5 addition during 2-year follow-up.
RESULTS
In total, 3062 new ICS/LABA FDC users were identified, of whom 120 (3.9%) received additional GINA-5 (OCS: 89; long-acting muscarinic antagonists: 39; biologics: <3). Mean time to commencing additional GINA-5 was 705.2 (standard deviation, 1.7) days. Adherence trajectories were nonpersistent use (20%), seasonal use (8%), poor adherence (58%), and good adherence (13%). Although poor adherence was associated with longer time to additional GINA-5 (adjusted hazard ratio: 0.58; 95% confidence interval: 0.35-0.95), over 80% of additional GINA-5 was commenced in poorly adherent patients. Use of ≥2 OCS/antibiotic courses also predicted additional GINA-5.
CONCLUSIONS
Almost 1 in 20 people with asthma commenced additional GINA-5 after ICS/LABA initiation, most of whom (>80%) were poorly adherent to inhaled preventers. There is a substantial unmet need for inhaler adherence to be addressed before prescribing additional GINA-5.

Identifiants

DOI: 10.1016/j.jaip.2019.12.002 PMID: 31857262
pubmed: 31857262
pii: S2213-2198(19)31022-0
doi: 10.1016/j.jaip.2019.12.002
pii:
doi:

Substances chimiques

Adrenal Cortex Hormones 0
Adrenergic beta-2 Receptor Agonists 0
Muscarinic Antagonists 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1961-1969.e6

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Auteurs

Job F M van Boven (JFM)

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, the Netherlands; Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, the Netherlands. Electronic address: j.f.m.van.boven@rug.nl.

Marjaana Koponen (M)

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.

Samanta Lalic (S)

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Pharmacy Department, Monash Health, Melbourne, VIC, Australia.

Johnson George (J)

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

J Simon Bell (JS)

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

Mark Hew (M)

School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, VIC, Australia.

Jenni Ilomaki (J)

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Voies d'administration de substances chimiques et des médicaments › Administration par inhalation › Trajectory Analyses of Adherence Patterns in a...
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questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Agents neuromédiateurs › Agents adrénergiques › Agonistes adrénergiques › Agonistes bêta-adrénergiques › Agonistes des récepteurs béta-2 adrénergiques › Trajectory Analyses of Adherence Patterns in a...
questionsmedicales.fr › Maladies du système immunitaire › Hypersensibilité › Hypersensibilité immédiate › Hypersensibilité respiratoire › Asthme › Trajectory Analyses of Adherence Patterns in a...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Trajectory Analyses of Adherence Patterns in a...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Association de médicaments › Trajectory Analyses of Adherence Patterns in a...
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questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Agents neuromédiateurs › Agents cholinergiques › Antagonistes cholinergiques › Antagonistes muscariniques › Trajectory Analyses of Adherence Patterns in a...