Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study.
asthma management
inhaler medication
longitudinal
observational
personalized medicine
respiratory disease
Journal
Clinical epidemiology
ISSN: 1179-1349
Titre abrégé: Clin Epidemiol
Pays: New Zealand
ID NLM: 101531700
Informations de publication
Date de publication:
2023
2023
Historique:
received:
08
03
2023
accepted:
08
05
2023
medline:
20
6
2023
pubmed:
20
6
2023
entrez:
20
6
2023
Statut:
epublish
Résumé
The Global Initiative for Asthma (GINA) suggests a step-wise approach for pharmacological treatment of asthma. Valid study of real-world treatment patterns using dispensing databases includes proper measurement of medication adherence. We aim to explore such patterns by applying a time-varying proportion of days covered (tPDC)-based algorithm. We designed a retrospective inception cohort study using the University of Groningen IADB.nl community pharmacy dispensing database. Included were 19,184 young adults who initiated asthma medication anywhere between 1994 and 2021, in the Netherlands. Main treatment steps were defined as: 1 - SABA/ICS-formoterol as needed, 2 - low dose ICS, 3 - low dose ICS + LABA or tiotropium, or intermediate dose ICS, 4 - intermediate to high dose ICS + LABA or tiotropium, triple therapy, or high dose ICS, 5 - treatment prescribed by a specialist. Changes in treatment steps were determined using a time-varying proportion of days covered (tPDC)-based algorithm. Individual drug treatment trajectories were visualized over time using a lasagna plot. At initiation, of the 19,184 included individuals, 52%, 7%, 15%, 16%, and 10% started treatment in steps 1 to 5, respectively. The median (IQR) follow-up time was 3 (1-7) years. Median (IQR) number of switches was 1 (0-3). Comparing starting step to last observed step, 37% never switched between treatment steps, 20% of individuals stepped down and 22% stepped up. The low proportion of treatment switches between steps indicates that tailoring of treatment to patients' needs might be suboptimal. The tPDC-based algorithm functions well in translating dispensing data into continuous drug-utilization data, enabling a more granular assessment of treatment patterns among asthma patients.
Identifiants
pubmed: 37337562
doi: 10.2147/CLEP.S410036
pii: 410036
pmc: PMC10276997
doi:
Types de publication
Journal Article
Langues
eng
Pagination
721-732Informations de copyright
© 2023 Mommers et al.
Déclaration de conflit d'intérêts
Dr Job FM van Boven reports grants and/or personal fees from AstraZeneca, Chiesi, GSK, Novartis, Teva, and Trudell Medical, outside the submitted work. The authors report no other conflicts of interest in this work.
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