Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids.
10.4168/aair.2017.9.2.116
- Author:
Dirkje S POSTMA
1
;
Richard DEKHUIJZEN
;
Thys VAN DER MOLEN
;
Richard J MARTIN
;
Wim VAN AALDEREN
;
Nicolas ROCHE
;
Theresa W GUILBERT
;
Elliot ISRAEL
;
Daniela VAN EICKELS
;
Javaria Mona KHALID
;
Ron M C HERINGS
;
Jetty A OVERBEEK
;
Cristiana MIGLIO
;
Victoria THOMAS
;
Catherine HUTTON
;
Elizabeth V HILLYER
;
David B PRICE
Author Information
1. University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands.
- Publication Type:Original Article
- Keywords:
Anti-asthmatic agents;
comparative effectiveness research;
disease exacerbation;
small airway
- MeSH:
Adrenal Cortex Hormones*;
Anti-Asthmatic Agents;
Asthma;
Cohort Studies;
Comparative Effectiveness Research;
Diethylpropion;
Disease Progression;
Gastroesophageal Reflux;
Hospitalization;
Humans;
Odds Ratio;
Prevalence;
Rhinitis
- From:Allergy, Asthma & Immunology Research
2017;9(2):116-125
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). METHODS: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. RESULTS: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. CONCLUSIONS: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.
