| Autor: |
Altawalbeh, Shoroq M., Thorpe, Carolyn T., Zgibor, Janice C., Kane‐Gill, Sandra, Kang, Yihuang, Thorpe, Joshua M. |
| Předmět: |
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| Zdroj: |
Journal of the American Geriatrics Society; Aug2016, Vol. 64 Issue 8, p1592-1600, 9p, 5 Charts |
| Abstrakt: |
Objectives To compare the effectiveness and cardiovascular safety of long-acting beta-agonists ( LABAs) with those of leukotriene receptor antagonists ( LTRAs) as add-on treatments in older adults with asthma already taking inhaled corticosteroids ( ICSs). Design Retrospective cohort study. Setting Medicare fee-for-service ( FFS) claims (2009-10) for a 10% random sample of beneficiaries continuously enrolled in Parts A, B, and D in 2009. Participants Medicare beneficiaries aged 66 and older continuously enrolled in FFS Medicare with Part D coverage with a diagnosis of asthma before 2009 treated exclusively with ICSs plus LABAs or ICSs plus LTRAs (N = 14,702). Measurements The augmented inverse propensity-weighted estimator was used to compare the effect of LABA add-on therapy with that of LTRA add-on therapy on asthma exacerbations requiring inpatient, emergency, or outpatient care and on cardiovascular ( CV) events, adjusting for demographic characteristics, comorbidities, and county-level healthcare-access variables. Results The primary analysis showed that LTRA add-on treatment was associated with greater odds of asthma-related hospitalizations or emergency department visits (odds ratio ( OR) = 1.4, P < .001), as well as outpatient exacerbations requiring oral corticosteroids or antibiotics ( OR = 1.41, P < .001) than LABA treatment. LTRA add-on therapy was also less effective in controlling acute symptoms, as indicated by greater use of short-acting beta agonists (rate ratio = 1.58, P < .001). LTRA add-on treatment was associated with lower odds of experiencing a CV event than LABA treatment ( OR = 0.86, P = .006). Conclusion This study provides new evidence specific to older adults to help healthcare providers weigh the risks and benefits of these add-on treatments. Further subgroup analysis is needed to personalize asthma treatments in this high-risk population. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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