Ann Chen Wu1, Lingling Li2, Vicki Fung3, Elyse O Kharbanda4, Emma K Larkin5, William M Vollmer6, Melissa G Butler7, Irina Miroshnik2, Donna Rusinak2, Robert L Davis7, Tina Hartert5, Scott T Weiss8, Tracy A Lieu9. 1. Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: ann.wu@childrens.harvard.edu. 2. Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass. 3. Mongan Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School, Boston, Mass. 4. Department of Research, HealthPartners Institute for Education and Research, Minneapolis, Minn. 5. Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn. 6. Center for Health Research-Northwest, Kaiser Permanente, Portland, Ore. 7. Center for Health Research-Southeast, Kaiser Permanente Georgia, Atlanta, Ga. 8. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Partners Center for Personalized Genetic Medicine, Partners Health Care, Boston, Mass. 9. Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
Abstract
BACKGROUND: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS. OBJECTIVE: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy. METHODS: This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use. RESULTS: Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS. CONCLUSION: Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.
BACKGROUND: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS. OBJECTIVE: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy. METHODS: This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use. RESULTS: Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS. CONCLUSION: Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.
Authors: Christine Y Lu; Fang Zhang; Matthew D Lakoma; Melissa G Butler; Vicki Fung; Emma K Larkin; Elyse O Kharbanda; William M Vollmer; Tracy Lieu; Stephen B Soumerai; Ann Chen Wu Journal: Clin Ther Date: 2015-04-25 Impact factor: 3.393
Authors: Alison A Galbraith; Vicki Fung; Lingling Li; Melissa G Butler; James D Nordin; John Hsu; David Smith; William M Vollmer; Tracy A Lieu; Stephen B Soumerai; Ann Chen Wu Journal: Health Serv Res Date: 2016-11-20 Impact factor: 3.402
Authors: Ann Chen Wu; Charlene Gay; Melisa D Rett; Natasha Stout; Scott T Weiss; Anne L Fuhlbrigge Journal: Pharmacogenomics Date: 2015-04-16 Impact factor: 2.533
Authors: Kedir N Turi; Tebeb Gebretsadik; Rees L Lee; Tina V Hartert; Amber M Evans; Cosby Stone; Nicholas M Sicignano; Ann C Wu; Carlos Iribarren; Melissa G Butler; Edward Mitchel; James Morrow; Emma K Larkin; Pingsheng Wu Journal: J Asthma Date: 2017-09-07 Impact factor: 2.515
Authors: Steve W Turner; Kathryn Richardson; Annie Burden; Mike Thomas; Clare Murray; David Price Journal: NPJ Prim Care Respir Med Date: 2015-06-11 Impact factor: 2.871
Authors: Elham Hossny; Nelson Rosario; Bee Wah Lee; Meenu Singh; Dalia El-Ghoneimy; Jian Yi Soh; Peter Le Souef Journal: World Allergy Organ J Date: 2016-08-12 Impact factor: 4.084