Background
There are sparse real‐world data on severe asthma exacerbations (SAE) in children. This multinational cohort study assessed the incidence of and risk factors for SAE and the incidence of asthma‐related rehospitalization in children with asthma.
Methods
Asthma patients 5‐17 years old with ≥1 year of follow‐up were identified in six European electronic databases from the Netherlands, Italy, the UK, Denmark and Spain in 2008‐2013. Asthma was defined as ≥1 asthma‐specific disease code within 3 months of prescriptions/dispensing of asthma medication. Severe asthma was defined as high‐dosed inhaled corticosteroids plus a second controller. SAE was defined by systemic corticosteroids, emergency department visit and/or hospitalization all for reason of asthma. Risk factors for SAE were estimated by Poisson regression analyses.
Results
The cohort consisted of 212 060 paediatric asthma patients contributing to 678 625 patient‐years (PY). SAE rates ranged between 17 and 198/1000 PY and were higher in severe asthma and highest in severe asthma patients with a history of exacerbations. Prior SAE (incidence rate ratio 3‐45) and younger age increased the SAE risk in all countries, whereas obesity, atopy and GERD were a risk factor in some but not all countries. Rehospitalization rates were up to 79% within 1 year.
Conclusions
In a real‐world setting, SAE rates were highest in children with severe asthma with a history of exacerbations. Many severe asthma patients were rehospitalized within 1 year. Asthma management focusing on prevention of SAE is important to reduce the burden of asthma.
The two-drug regimen dolutegravir plus lamivudine demonstrated durable efficacy for up to 3 years in phase III studies and a high barrier to resistance in treatment-naive and virologically suppressed people with HIV (PWH). This systematic literature review summarizes real-world evidence evaluating effectiveness and safety of dolutegravir plus lamivudine. We searched Ovid MEDLINE
Dolutegravir (DTG) is widely recommended within three-drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two-drug regimens in clinical trials. This study evaluated the real-world effectiveness and discontinuations in people living with HIV-1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV).
MethodsThis was a one-arm meta-analysis utilizing data from a systematic literature review. Data from real-world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations.
ResultsPooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4-1.3] and 0.6% (95% CI: 0.0-1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3-87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0-97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1-16.2) and 7.2% (95% CI: 2.1-14.4) of patients, respectively, at W48. Similar results were observed at W96.
ConclusionsTreatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.
Background: There is sparse real life evidence on the risk factors and incidence of asthma exacerbations (AE) in children. Aims: To assess incidence and risk factors of AE in children with moderate to severe asthma in real life. Methods: Patients aged 5-17 years with ≥1 year of follow-up were identified in six European electronic health record databases from the Netherlands, Italy, UK, Denmark and Spain in 2008-2013. Asthma was defined as >1 asthma prescription within 3 months of an asthma diagnose code, severe asthma also required use of high dose inhaled corticosteroids combined with controller therapy. AE was defined as need of oral steroids, emergency department visit or hospitalization for asthma. Risk factors for AE were estimated by multivariate Poisson regression analyses. Results: The cohort consisted of 226, 343 asthma patients (mean age in the databases 7.2-14.8 years), contributing 723, 674 patient years (PY). The proportion of severe asthma ranged between 1.6-15.5%. AE rates ranged between 17-188/1, 000 PY, and were higher in severe asthma patients (41-326/1, 000 PY). In most databases girls had a higher AE rate than boys from adolescence on, and vice versa in young children. The risk was mainly increased by previous AE (incidence rate: 3-29), and also by atopy and high blood eosinophilia (≥300 cells/uL). Obesity was a risk factor of AE in some databases. Conclusions: In a real world setting, we showed high AE rates, with highest rates in children with severe asthma. Risk of exacerbation depended on age, gender, comorbidities and previous AE. Asthma management focusing on prevention of AE is important to reduce the burden of asthma.
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