TY - JOUR
T1 - Effect of Stepping Up to High-Dose Inhaled Corticosteroids in Patients With Asthma
T2 - UK Database Study
AU - Pavord, Ian D.
AU - Tran, Trung N.
AU - Jones, Rupert C.
AU - Nuevo, Javier
AU - van den Berge, Maarten
AU - Brusselle, Guy G.
AU - Menzies-Gow, Andrew N.
AU - Skinner, Derek
AU - Carter, Victoria
AU - Kocks, Janwillem W.H.
AU - Price, David B.
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2023/2
Y1 - 2023/2
N2 - Background: It is unclear whether patients with asthma benefit from stepping up to high-dose inhaled corticosteroids (ICSs). Objective: To determine the effectiveness of stepping up to high-dose ICSs. Methods: A historic cohort study of patients with asthma (≥13 years old), identified from 2 large UK electronic medical record databases, was conducted. Patients who remained on medium-dose ICSs were compared with those who stepped up from medium- to high-dose ICSs, whereas patients who stepped up from low- to medium-dose ICSs were compared with those who stepped up from low- to high-dose ICSs. Time to first severe exacerbation (primary outcome) between treatment groups was compared using multivariable Cox proportional hazards models, and the number of exacerbations and antibiotics courses was analyzed using negative binomial regression. Inverse probability of treatment weighting was used to handle confounding. Results: The mean follow-up time to first exacerbation was 2.7 ± 2.7 years for those who remained on stable medium-dose ICSs and 2.0 ± 2.2 years for those who stepped up from medium- to high-dose ICSs. A similar pattern was noted for those who stepped up from low- to medium-dose ICSs (2.6 ± 2.5 years) and from low- to high-dose ICSs (2.3 ± 2.5 years). Patients who stepped up from medium- to high-dose ICSs (n = 6879) had a higher risk of exacerbations during follow-up compared with those who remained on medium-dose ICSs (n = 51,737; hazard ratio, 1.17; 95% CI, 1.12-1.22). This was similar in patients stepping up from low- to high-dose (n = 3232) compared with low- to medium-dose (n = 12,659) ICSs (hazard ratio, 1.10; 95% CI, 1.04-1.17). A step-up to high-dose ICSs was also associated with a higher number of asthma exacerbations and antibiotics courses. No significant difference in associations was found across subgroups of patients with different blood eosinophil counts. Conclusions: We found no evidence that a step-up to high-dose ICSs is effective in preventing future asthma exacerbations.
AB - Background: It is unclear whether patients with asthma benefit from stepping up to high-dose inhaled corticosteroids (ICSs). Objective: To determine the effectiveness of stepping up to high-dose ICSs. Methods: A historic cohort study of patients with asthma (≥13 years old), identified from 2 large UK electronic medical record databases, was conducted. Patients who remained on medium-dose ICSs were compared with those who stepped up from medium- to high-dose ICSs, whereas patients who stepped up from low- to medium-dose ICSs were compared with those who stepped up from low- to high-dose ICSs. Time to first severe exacerbation (primary outcome) between treatment groups was compared using multivariable Cox proportional hazards models, and the number of exacerbations and antibiotics courses was analyzed using negative binomial regression. Inverse probability of treatment weighting was used to handle confounding. Results: The mean follow-up time to first exacerbation was 2.7 ± 2.7 years for those who remained on stable medium-dose ICSs and 2.0 ± 2.2 years for those who stepped up from medium- to high-dose ICSs. A similar pattern was noted for those who stepped up from low- to medium-dose ICSs (2.6 ± 2.5 years) and from low- to high-dose ICSs (2.3 ± 2.5 years). Patients who stepped up from medium- to high-dose ICSs (n = 6879) had a higher risk of exacerbations during follow-up compared with those who remained on medium-dose ICSs (n = 51,737; hazard ratio, 1.17; 95% CI, 1.12-1.22). This was similar in patients stepping up from low- to high-dose (n = 3232) compared with low- to medium-dose (n = 12,659) ICSs (hazard ratio, 1.10; 95% CI, 1.04-1.17). A step-up to high-dose ICSs was also associated with a higher number of asthma exacerbations and antibiotics courses. No significant difference in associations was found across subgroups of patients with different blood eosinophil counts. Conclusions: We found no evidence that a step-up to high-dose ICSs is effective in preventing future asthma exacerbations.
UR - http://www.scopus.com/inward/record.url?scp=85143284938&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2022.10.040
DO - 10.1016/j.jaip.2022.10.040
M3 - Article
C2 - 36371063
AN - SCOPUS:85143284938
SN - 2213-2198
VL - 11
SP - 532
EP - 543
JO - Journal of Allergy and Clinical Immunology: In Practice
JF - Journal of Allergy and Clinical Immunology: In Practice
IS - 2
ER -