Short-acting β2-agonist exposure and severe asthma exacerbations: SABINA findings from Europe and North America

Autor: Jennifer K. Quint, Sofie Arnetorp, Janwillem W.H. Kocks, Maciej Kupczyk, Javier Nuevo, Vicente Plaza, Claudia Cabrera, Chantal Raherison-Semjen, Brandie Walker, Erika Penz, Ileen Gilbert, Njira Lucia Lugogo, Ralf J.P. van der Valk, Andrew Fong, Christina Qian, Caroline Fabry-Vendrand, Chantal Touboul, Dorota Brzostek, Ekaterina Maslova, Filip Surmont, Helena Goike, Hitesh Gandhi, J.C. Korevaar, Joseph Tkacz, Karissa Johnston, Keith Peres da Costa, L. van Dijk, M. Vervloet, Michael Pollack, Paul Hernandez, Silvia Boarino, Stephen G. Noorduyn, Wendy Beekman-Hendricks, Y.M. Weesie
Přispěvatelé: AstraZeneca UK Limited, Groningen Research Institute for Asthma and COPD (GRIAC), PharmacoTherapy, -Epidemiology and -Economics, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: 2309.10
Journal of Allergy and Clinical Immunology: In Practice, 10(9), 2297-2309.e10. American Academy of Allergy, Asthma and Immunology
ISSN: 2213-2198
Popis: Background: Expert national/global asthma management recommendations raise the issue whether a safe threshold of short-acting beta-2 agonist (SABA) use without concomitant inhaled corticosteroids (ICS) exists.Objective: To examine SABA and maintenance therapy associations with severe asthma exacerbations across North America and Europe.Methods: Observational analyses of 10 SABa use IN Asthma (SABINA) datasets involving 1,033,564 patients (≥12 y) from Canada, France, the Netherlands, Poland, Spain, the United Kingdom, and the United States. Negative binomial models (incidence rate ratio [IRR] [95% CI adjusted for prespecified-covariates]) evaluated associations between SABA and exacerbations.Results: Across severities, 40.2% of patients were prescribed/possessed 3 or more SABA canisters/y. Per the Global Initiative for Asthma (GINA) 2018 definitions, steps 3 to 5–treated patients prescribed/possessing 3 or more versus 1 or 2 SABAs experienced more severe exacerbations (IRR 1.08 [95% CI 1.04‒1.13], U.S. Medicare; IRR 2.11 [95% CI 1.96‒2.27], Poland). This association was not observed in all step 1 or 2–treated patients (the Netherlands, IRR 1.25 [95% CI 0.91‒1.71]; U.S. commercial, IRR 0.92 [95% CI 0.91‒0.93]; U.S. Medicare, IRR 0.74 [95% CI 0.71‒0.76]). We hypothesize that this inverse association between SABA and severe exacerbations in the U.S. datasets was attributable to the large patient population possessing fewer than 3 SABA and no maintenance therapy and receiving oral corticosteroid bursts without face-to-face health care provider encounters. In U.S. SABA monotherapy–treated patients, 3 or more SABAs were associated with more emergency/outpatient visits and hospitalizations (IRR 1.31 [95% CI 1.29‒1.34]). Most GINA 2 to 5–treated study patients (60.6%) did not have maintenance therapy for up to 50% of the time; however, the association of 3 or more SABAs and severe exacerbations persisted (IRR 1.32 [95% CI 1.18‒1.49]) after excluding these patients and the independent effect was further confirmed when U.K. SABA data were analyzed as a continuous variable in patients with up to 100% annual coverage for ICS-containing medications.Conclusions: Increasing SABA exposure is associated with severe exacerbation risk, independent of maintenance therapy. As addressed by GINA, based on studies across asthma severities where as-needed fast-acting bronchodilators with concomitant ICS decrease severe exacerbations compared with SABA, our findings highlight the importance of avoiding a rescue/reliever paradigm utilizing SABA monotherapy.
Databáze: OpenAIRE
Externí odkaz: