Modelling Asthma Treatment Dynamics: Insights from the g-Formula.

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology Pub Date : 2025-03-13 eCollection Date: 2025-01-01 DOI:10.2147/CLEP.S486869

Irene Mommers, Job F M van Boven, Jens H J Bos, Sumaira Mubarik, Eelko Hak, Maarten J Bijlsma

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引用次数: 0

Abstract

Purpose: The g-formula offers a promising approach to analyze long-term dynamic asthma treatment trajectories. This study investigates whether the g-formula can simulate real-world asthma treatment trajectories and predicts subgroup differences in switching behavior.

Patients and methods: This retrospective cohort study identified individuals aged 16- to 45 years who initiated inhaled asthma medication in the Netherlands between 1994 and 2021, from the IADB.nl pharmacy dispensing database. We used the g-formula combined with logistic regression to predict treatment trajectories and their associations with various patient characteristics, such as age, sex, chronic drug treatment for atopic diseases (ATD), cardiovascular diseases (CVD), thyroid diseases, arthritis, diabetes, gastroesophageal reflux disease (GERD), mental health problems (MHP), and immunosuppressants.

Results: The simulations predicted 76% of individuals to switch treatment, on average 2.3 times, with the first switch occurring on average after 8.3 months, which agrees with the real-world observations (77%, 2.3 times and 7.9 months, respectively). Fewer 45-year-olds switched treatment compared to 16-year-olds (74% vs 78%, p < 0.001), but they switched earlier (8.1 vs 8.6 months, p < 0.001) and more frequently (2.4 vs 2.3 times, p < 0.001). Women were more likely to switch compared to men. Patients with ATD, CVD, MHP, or GERD switched significantly less often (p < 0.05).

Conclusion: The g-formula effectively simulates asthma treatment trajectories and found higher age, male sex, ATD, CVD, MHP, and GERD to decrease overall switching behavior. These patients might benefit from earlier intervention or closer monitoring to reduce delays in treatment progression.

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哮喘治疗动力学建模：来自g公式的见解。

目的：g公式提供了一种很有前途的方法来分析长期动态哮喘治疗轨迹。这项研究调查了g公式是否可以模拟真实的哮喘治疗轨迹，并预测切换行为的亚组差异。患者和方法：这项回顾性队列研究确定了1994年至2021年间在荷兰开始吸入哮喘药物治疗的16至45岁的个体，来自IADB。Nl药房调剂数据库。我们使用g公式结合逻辑回归来预测治疗轨迹及其与各种患者特征的关系，如年龄、性别、特应性疾病（ATD）、心血管疾病（CVD）、甲状腺疾病、关节炎、糖尿病、胃食管反流病（GERD）、精神健康问题（MHP）和免疫抑制剂的慢性药物治疗。结果：模拟预测76%的个体转换治疗，平均2.3次，第一次转换平均发生在8.3个月后，这与现实世界的观察结果一致（分别为77%，2.3次和7.9个月）。与16岁的人相比，45岁的人较少切换治疗（74%对78%，p < 0.001），但他们切换得更早（8.1个月对8.6个月，p < 0.001）和更频繁（2.4次对2.3次，p < 0.001）。与男性相比，女性更有可能换工作。ATD、CVD、MHP或GERD患者的切换频率显著降低（p < 0.05）。结论：g公式有效地模拟了哮喘治疗轨迹，发现年龄、男性、ATD、CVD、MHP和GERD的增加会降低整体转换行为。这些患者可能受益于早期干预或更密切的监测，以减少治疗进展的延误。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.