Disease burden and treatment adherence among children and adolescent patients with asthma

Abstract

Objective: To assess asthma burden and medication adherence in a US de-identified patient level claims database. Methods: This retrospective observational study used the IQVIA PHARMETRICS PLUS database to identify patients aged 5-17 years, diagnosed with asthma between 01/01/2012-09/30/2017 (asthma cohort), and those initiating treatment with twice-daily inhaled corticosteroids (ICS) or twice-daily ICS/long-acting beta 2 agonists (LABA) (treatment cohorts; index date = first dispensing). Patient characteristics, asthma medication, and healthcare resource utilization were assessed over a 12-month baseline period. Treatment cohort endpoints were assessed in a 12-month follow-up period, including: adherence using proportion of days covered (PDC); persistence (no gap >45 days between dispensings). Results: The asthma cohort included 186,868 patients (112,689 children, mean age 7.9 years; 74,179 adolescents, mean age 14.3 years). During baseline, 34.5% used ICS or ICS/LABA, 24% used oral corticosteroids, 11.1% had ≥1 asthma-related emergency department visit, 2.2% had ≥1 asthma-related hospitalization. Among treatment cohorts, 47,276 and 10,247 patients initiated twice-daily ICS and ICS/LABA, respectively (mean ages: 9.9; 12.5 years). Mean PDC adherence to twice-daily ICS and ICS/LABA was 30% and 34% at 6 months (PDC ≥0.8: 4.3%; 6.1%); 21% and 24% at 12 months (PDC ≥0.8: 1.8%; 2.8%). Persistence with twice-daily ICS and ICS/LABA was 10.1% and 14.2% at 6 months; 5.6% and 8.0% at 12 months. Conclusions: A large disease burden and unmet need exist among US children/adolescent asthma patients, evidenced by low use of, and poor adherence to, ICS-containing medication, the notable proportion of oral corticosteroid users, and higher-than-expected asthma-related emergency department and hospitalization rates.

Global burden of pediatric asthma and rhinitis – what we have recently learned from epidemiology

“…The results of this study show that the mean PDC adherence for ICS and ICS/LABA, respectively, was 30% and 34% at 6 months after use and 21% and 24% at 12 months after initiation. These data show that patients with low utilization and poor adherence to prescribed medications for asthma control, contribute in notable proportion in the indication of oral corticosteroid use, in addition to higher emergency department visits and hospitalization [12 ▪ ].…”

Asthma and COPD: Comparison with International Guidelines and Medication Adherence in Belgium

“…Indeed, the dosage of each drug may also play a role in adherence. For asthma and COPD, it has been shown that adherence tended to be better if the medication was taken once a day instead of twice a day [ 41 , 42 , 43 , 44 ]. In our results, LABA-LAMA combinations had the highest proportion of adherent patients (75.66%), and almost all the drugs had to be taken once a day.…”

Effects of Adherence to Once-Daily Treatment on Lung Function, Bronchial Hyperreactivity and Health Outcomes in Adolescents with Mild-to-Moderate Asthmoka: A Twelve-Month Survey

“…Similar data were confirmed in a large study conducted on more than 70,000 adolescents with asthma: their adherence to twice-daily ICS/LABA resulted in 34% compliance at six months and 24% at twelve months [ 32 ]. It is of note that therapeutic strategies based on more than two inhalations per day and/or through different devices proved to contribute negatively in terms of adherence [ 33 ].…”