| アブストラクト | OBJECTIVE: To examine the comparative effectiveness of inhaled long-acting beta-agonist (LABA), inhaled corticosteroid (ICS), and ICS/LABA combinations. METHODS: We used a retrospective cohort design of patients older than 12 years with asthma diagnosis in the Clinical Practice Research Datalink to evaluate asthma-related morbidity measured by oral corticosteroid (OCS) initiation within 12 months of initiating LABAs, ICSs, or ICSs/LABAs. Asthma severity 12 months before drug initiation (use of OCSs, asthma-related hospital or emergency department visits, and number of short-acting beta-agonist prescriptions) and during follow-up (short-acting beta-agonist prescriptions and total number of asthma drug classes) was adjusted as a time-varying variable via marginal structural models. RESULTS: A total of 51,103 patients with asthma were followed for 12 months after receiving first prescription for study drugs from 1993 to 2010. About 92% initiated ICSs, 1% initiated LABAs, and 7% initiated ICSs/LABAs. Compared with ICSs, LABAs were associated with a 10% increased risk of asthma exacerbations requiring short courses of OCSs (hazard ratio [HR] 1.10; 95% confidence interval [CI] 1.07-1.18). ICS/LABA initiators were 62% less likely than ICS initiators (HR 0.38; 95% CI 0.12-0.66) and 50% less likely than LABA initiators to receive OCS prescriptions for asthma exacerbations (HR 0.50; 95% CI 0.14-0.78). CONCLUSIONS: In concordance with current asthma management guidelines, inhaled LABAs should not be prescribed as monotherapy to patients with asthma. The findings suggest the presence of time-dependent confounding by asthma severity, which was accounted for by the marginal structural model. |
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| 組織名 | Global Patient Safety, Eli Lilly and Company, Indianapolis, IN, USA; Department;of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana;University, Indianapolis, IN, USA; Department of Pharmaceutical Outcomes and;Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.;Electronic address: ayadali@alumni.ufl.edu.;Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University;of Florida, Gainesville, FL, USA; Department of Epidemiology, College of Public;Health and Health Professions and College of Medicine, University of Florida,;Gainesville, FL, USA.;of Florida, Gainesville, FL, USA.;of Florida, Gainesville, FL, USA; Deans Office, College of Pharmacy, University;Department of Biostatistics, College of Public Health and Health Professions and;College of Medicine, University of Florida, Gainesville, FL, USA.;Department of Pharmacotherapy and Translational Research, College of Pharmacy,;University of Florida, Gainesville, FL, USA. |
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