TY - JOUR
T1 - The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes
T2 - A Multilevel Approach
AU - Respiratory Effectiveness Group's Adherence Working Group
AU - Vervloet, Marcia
AU - van Dijk, Liset
AU - Spreeuwenberg, Peter
AU - Price, David
AU - Chisholm, Alison
AU - Van Ganse, Eric
AU - Pinnock, Hilary
AU - Rand, Cynthia S.
AU - Eakin, Michelle N.
AU - Schermer, Tjard
AU - Souverein, Patrick C.
AU - Dima, Alexandra L.
N1 - Funding Information:
This study was funded by the Respiratory Effectiveness Group, an international, investigator-led, not-for-profit, real-life respiratory research and advocacy initiative (http://www.effectivenessevaluation.org). The data set was provided by Optimum Patient Care Ltd as a donation in kind.Conflicts of interest: M. Vervloet and L. van Dijk received funding for research unrelated to this study from Pfizer, AbbVie, and AstraZeneca. D. Price has board membership with Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Mylan, Mundipharma, Napp, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and Teva Pharmaceuticals; consultancy agreements with Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer Ingelheim, British Lung Foundation, Chiesi, Mylan, Mundipharma, Napp, Novartis, Pfizer, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Teva Pharmaceuticals, Theravance, UK National Health Service, and Zentiva (Sanofi Generics); payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Merck, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, Skyepharma, and Teva Pharmaceuticals; payment for manuscript preparation from Mundipharma and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma and Novartis; payment for travel/accommodation/meeting expenses from Aerocrine, AstraZeneca, Boehringer Ingelheim, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals; funding for patient enrollment or completion of research from Chiesi, Novartis, Teva Pharmaceuticals, and Zentiva (Sanofi Generics); stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); and is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation Programme program, and Health Technology Assessment Programme. E. van Ganse reports personal fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, IQVIA, Merck Sharp and Dohme, and PELyon; and grants from Bayer, BMS, GlaxoSmithKline, and Merck Sharp and Dohme, outside the submitted work. P. C. Souverein has received research support from the Respiratory Effectiveness Group. C. S. Rand serves as a member of Scientific Advisory Boards for Teva Pharmaceuticals and GlaxoSmithKline. T. Schermer received funding for research unrelated to this study from GlaxoSmithKline and Boehringer Ingelheim. The rest of the authors declare that they have no relevant conflicts of interest.
Funding Information:
This study was funded by the Respiratory Effectiveness Group , an international, investigator-led, not-for-profit, real-life respiratory research and advocacy initiative ( http://www.effectivenessevaluation.org ). The data set was provided by Optimum Patient Care Ltd as a donation in kind.
Publisher Copyright:
© 2019 American Academy of Allergy, Asthma & Immunology
PY - 2020/2
Y1 - 2020/2
N2 - Background: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences. Objective: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence. Methods: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics. Results: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non–current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation. Conclusions: Patients may adapt their ICS use to their current needs without this impacting later RDAC.
AB - Background: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences. Objective: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence. Methods: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics. Results: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non–current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation. Conclusions: Patients may adapt their ICS use to their current needs without this impacting later RDAC.
KW - Adherence
KW - Inhaled corticosteroids (ICSs)
KW - Longitudinal study
KW - Multilevel modeling
KW - OPCRD
KW - Risk domain asthma control
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U2 - 10.1016/j.jaip.2019.09.003
DO - 10.1016/j.jaip.2019.09.003
M3 - Article
C2 - 31541763
AN - SCOPUS:85073029540
SN - 2213-2198
VL - 8
SP - 626
EP - 634
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 2
ER -