Hilda J I De Jong1, Jaco Voorham1, Glenis K Scadding2, Claus Bachert3, Giorgio Walter Canonica4, Peter Smith5, Ulrich Wahn6, Dermot Ryan7,8, Jose A Castillo9, Victoria A Carter8, Ruth B Murray8, David B Price1,8,10. 1. Observational and Pragmatic Research Institute, Singapore. 2. Royal National Throat, Nose and Ear Hospital, University College London School of Medicine, London, UK. 3. Ghent University Hospital, Ghent, Belgium. 4. Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, SANI-Severe Asthma Network, Milan, Italy. 5. Griffith University, Southport, QLD, Australia. 6. Charité Medical University, Berlin, Germany. 7. Usher Institute, University of Edinburgh, Edinburgh, UK. 8. Optimum Patient Care, Cambridge, UK. 9. Hospital Universitari Quirón Dexeus, Barcelona, Spain. 10. Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Abstract
BACKGROUND: MP-AzeFlu (Dymista®; spray of azelastine/fluticasone propionate) is the most effective allergic rhinitis (AR) treatment available. Its effect on asthma outcomes in patients with AR and asthma is unknown. METHODS: This pre-post historical cohort study, using the Optimum Patient Care Research Database, included patients aged ≥12 years, from UK general practice with active asthma (defined as a recorded diagnosis, with ≥1 prescription for reliever or controller inhaler) in the year before or at the initiation date. The primary study outcome was change in number of acute respiratory events (i.e. exacerbation or antibiotic course for a respiratory event) between baseline and outcome years. The effect size of MP-AzeFlu was quantified as the difference in % of patients that improved and worsened. RESULTS: Of the 1,188 patients with AR and asthma included, many had a record of irreversible obstruction (67%), and uncontrolled asthma (70.4%), despite high mean daily doses of reliever/controller therapy and acute oral corticosteroid use, in the year pre-MP-AzeFlu initiation. MP-AzeFlu initiation was associated with fewer acute respiratory events (effect size (e) = 5.8%, p = 0.0129) and a reduction in daily use of short-acting β2-agonists, with fewer patients requiring >2 SABA puffs/week (e = 7.7% p < 0.0001). More patients had well-controlled asthma 1-year post-MP-AzeFlu initiation (e = 4.1%; p = 0.0037), despite a reduction in inhaled corticosteroids (e = 4.8%; p = 0.0078). CONCLUSIONS: This study provides the first direct evidence of the beneficial effect of MP-AzeFlu on asthma outcomes in co-morbid patients in primary care in the United Kingdom. TRIAL REGISTRATION: EUPAS30940. Registered August 13, 2019.
BACKGROUND: MP-AzeFlu (Dymista®; spray of azelastine/fluticasone propionate) is the most effective allergic rhinitis (AR) treatment available. Its effect on asthma outcomes in patients with AR and asthma is unknown. METHODS: This pre-post historical cohort study, using the Optimum Patient Care Research Database, included patients aged ≥12 years, from UK general practice with active asthma (defined as a recorded diagnosis, with ≥1 prescription for reliever or controller inhaler) in the year before or at the initiation date. The primary study outcome was change in number of acute respiratory events (i.e. exacerbation or antibiotic course for a respiratory event) between baseline and outcome years. The effect size of MP-AzeFlu was quantified as the difference in % of patients that improved and worsened. RESULTS: Of the 1,188 patients with AR and asthma included, many had a record of irreversible obstruction (67%), and uncontrolled asthma (70.4%), despite high mean daily doses of reliever/controller therapy and acute oral corticosteroid use, in the year pre-MP-AzeFlu initiation. MP-AzeFlu initiation was associated with fewer acute respiratory events (effect size (e) = 5.8%, p = 0.0129) and a reduction in daily use of short-acting β2-agonists, with fewer patients requiring >2 SABA puffs/week (e = 7.7% p < 0.0001). More patients had well-controlled asthma 1-year post-MP-AzeFlu initiation (e = 4.1%; p = 0.0037), despite a reduction in inhaled corticosteroids (e = 4.8%; p = 0.0078). CONCLUSIONS: This study provides the first direct evidence of the beneficial effect of MP-AzeFlu on asthma outcomes in co-morbid patients in primary care in the United Kingdom. TRIAL REGISTRATION: EUPAS30940. Registered August 13, 2019.
Authors: Eli Meltzer; Paul Ratner; Claus Bachert; Warner Carr; William Berger; G Walter Canonica; James Hadley; Phil Lieberman; Frank C Hampel; Joaquim Mullol; Ullrich Munzel; David Price; Glenis Scadding; J Christian Virchow; Ulrich Wahn; Ruth Murray; Jean Bousquet Journal: Int Arch Allergy Immunol Date: 2013-05-04 Impact factor: 2.749
Authors: David Price; Linda Kemp; Erika Sims; Julie von Ziegenweidt; Prakash Navaratnam; Amanda J Lee; Alison Chisholm; Elizabeth V Hillyer; Gokul Gopalan Journal: Prim Care Respir J Date: 2010-09
Authors: I Kortekaas Krohn; I Callebaut; Y A Alpizar; B Steelant; L Van Gerven; P S Skov; A Kasran; K Talavera; M M Wouters; J L Ceuppens; S F Seys; P W Hellings Journal: Allergy Date: 2018-01-17 Impact factor: 13.146