Te-Jung Kung, Ching-Fu Weng, Shan-Chieh Wu, Fang-Ju Lin
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引用次数: 0
Abstract
Background: Inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) therapy is a mainstay of asthma management, yet real-world comparative evidence across different formulations remains limited.
Objective: This study aimed to compare the effectiveness of prescribed fixed-dose ICS/LABA combinations in reducing moderate-to-severe asthma exacerbations (MSAEs) among adults, stratified by initial ICS dose.
Methods: This retrospective cohort study utilized data from Taiwan's National Health Insurance Research Database and Cause of Death Registry (2016-2021). Adults with asthma who initiated fixed-dose ICS/LABA therapy between 2017 and 2020 were included. Treatment groups comprised budesonide/formoterol (reference), extrafine beclometasone dipropionate/formoterol, fluticasone propionate/salmeterol, and fluticasone furoate/vilanterol. Patients were stratified by initial ICS dosage into low-dose and medium-to-high-dose cohorts. Risk of MSAE was assessed using Cox proportional hazards model with inverse probability of treatment weighting for covariate adjustment.
Results: Among 128,426 eligible patients, 35,532 were in the low-dose and 88,954 in the medium-to-high-dose cohort. In the low-dose cohort, extrafine beclometasone dipropionate/formoterol (HR: 0.97, 95% confidence interval [CI]: 0.88-1.09) and fluticasone propionate/salmeterol (HR: 1.16, 95% CI: 0.98-1.37) had a similar risk of MSAE compared to budesonide/formoterol. In the medium-to-high-dose cohort, fluticasone furoate/vilanterol was associated with a slightly lower MSAE risk compared to budesonide/formoterol (HR: 0.92, 95% CI: 0.86-0.97), particularly in those with prior exacerbations (HR: 0.84, 95% CI: 0.77-0.91). Extrafine beclometasone dipropionate/formoterol (HR: 0.96, 95% CI: 0.89-1.04) and fluticasone propionate/salmeterol (HR: 1.06, 95% CI: 0.98-1.15) showed no significant difference.
Conclusion: The findings suggest that fluticasone furoate/vilanterol may offer a potential advantage for asthma management compared to other fixed-dose ICS/LABA combinations.
期刊介绍：
Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.
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