Inhaled corticosteroids plus formoterol are associated with fewer asthma exacerbations
Maintenance and relief therapy using inhaled corticosteroids and formoterol is associated with a lower risk for asthma exacerbations, according to a study published in Journal of Allergy and Clinical Immunology: In Practice.
This strategy also reduces the need for corticosteroids. Chungsoo Kim, PharmD, write a graduate student in the biomedical sciences department, Graduate School of Medicine at Ajou University, Suwon, Republic of Korea, and colleagues.
Data comes from Kim C, et al. J Allergy Clinic Immunol Practice. 2022;doi:10.1016/j.jaip.2022.06.009.
The Global Initiative Guidelines for Asthma currently recommend maintenance and relief therapy (MART) consisting of an inhaled corticosteroid (ICS) and a long-acting beta 2 agonist (LABA) for the management of adult asthma. However, such combinations are rarely evaluated using real-world data.
The researchers examined the records of adults with asthma aged 18 to 75 who visited Ajou University Medical Center between January 2008 and July 2021.
The population included 296 patients treated with MART (mean age, 43.3 ± 15.7 years; 43.9% women; mean Charlson Comorbidity Index, 0.5 ± 0.6) and 950 patients treated with MART. ICS, LABA and short-acting beta 2 agonist as needed, or SABA (non-MART; mean age, 45.3 ± 15.7 years, 47.5% women; mean Charlson Comorbidity Index, 0.5 ± 1.8.).
The mean cumulative dose of chronic steroids was 445.2 mg/year for the non-MART group and 187.2 mg/year for the MART group at baseline. Also, 17.6% of the non-MART group and 11.6% of the MART group had previous exacerbations.
The mean duration of follow-up was 120 days (interquartile range) [IQR]60–439) in the MART group and 68 days (IQR, 60–315) in the non-MART group.
Patients in the MART group had a significantly lower risk of severe asthma exacerbation per 1,000 person-years compared with the non-MART group (incidence rate [IR], 64.8 vs. 199.6; HR = 0.39; 95% CI, 0.18-0.77).
Specifically, 94.8% of the MART group had no severe asthma exacerbations, 4.8% had one or two, and 0.4% had three or more, which the investigators found significantly fewer than the non-MART group (P < .01).
The MART group also had a significantly lower risk of asthma exacerbation of any severity per 1,000 person-years than the non-MART group (IR, 152 vs. 320.2; HR = 0.61; 95% CI, 0, 37-0.99). In fact, the proportion of participants experiencing three or more exacerbations was higher in the non-MART group (P < .01).
However, the investigators found no difference in the risk of hospitalization (HR = 0.88; 95% CI, 0.55-1.37) or for pneumonia (HR = 0.63; 95% CI, 0.03-4.51). ) between the two groups. The MART group had 0.4% incidence of pneumonia, while the non-MART group had 1% incidence, which the investigators said was not significantly different.
A greater proportion of the MART group vs. the non-MART group had oral steroid prescriptions (45.9% vs 33.8%; P < 0.01), although the non-MART group had twice the proportion of steroid injections compared to the MART group (12.3% vs. 6.06%; P = .01).
In addition, the MART group had a lower cumulative corticosteroid dose (median, 190 mg/person-year; IQR, 97.9-420) than the non-MART group (median, 411 mg/person-year; IQR, 143.0 -883.0; P < .01), with lower oral and injectable dosage types as well.
Calling their study the first comprehensive analysis of real-world data on its clinical benefits, the investigators concluded that MART was more effective than ICS-LABA plus SABA therapy with a significant reduction in the risk of severe asthma exacerbations, asthma exacerbations, and systemic corticosteroid requirement without increasing the risk of pneumonia.
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