Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

Abstract

PurposeExtrafine-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).MethodsThis 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.ResultsEach 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.ConclusionsIn 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.

An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma

“…We compared extrafine-particle inhaled corticosteroid (ICS) to larger fine-particle ICS – a comparison that has been investigated previously 14. We found that extrafine-particle ICS was associated with similar or better asthma-related outcomes than a larger fine-particle ICS at significantly lower prescribed doses 15. In this study, we aim to compare the performance of exact matching with that of PSM by applying these methods in this historical cohort study, including both balance diagnostics and the impact on the primary endpoint of the original study.…”

Significant Role of Small Respiratory Tracts: New Possibilities of Cyclesonide in Therapy of Bronchial Asthma

“…Результаты аналогичного анализа с выделением в отдельную группу больных, получавших циклесонид, были опубликованы в 2017 г. [41]. В каждой из групп (по 1244 пациента) основные демографические и клинические показатели были сопоставимы, но в группе получавших циклесонид число связанных с БА госпитализаций превышало этот показатель в группе сравнения.…”

“…В каждой из групп (по 1244 пациента) основные демографические и клинические показатели были сопоставимы, но в группе получавших циклесонид число связанных с БА госпитализаций превышало этот показатель в группе сравнения. Анализ результатов терапии в течение 1 года показал, что при назначении циклесонида (средняя доза -160 мкг ГКС в пересчете на флутиказон) количество обострений было существенно ниже, пациенты имели значительно большие шансы достичь и поддерживать контроль заболевания, реже требовалось увеличение суточной дозы ИГКС, при средней суточной дозе циклесонида в пересчете на флутиказон на 1/3 ниже, чем в группе сравнения [41].…”

Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data

“…To this end, we aimed to evaluate the clinical utility of several asthma database outcomes used in our previous studies. 16 – 18 In particular, we investigated the following: 1) how useful these database outcomes were for providing insights into asthma control, compared to information gained from patient-reported questionnaires; 2) how well the database outcomes performed in assessing response to effective treatment; and 3) how well the database outcomes predicted future asthma exacerbations. To do this, we used database electronic medical records (EMRs) and linked questionnaire data from a large population of patients with asthma managed in routine primary care in the UK.…”