Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations : SABINA Findings From Europe and North America
Quint, Jennifer K. (Imperial College London)
Arnetorp, Sofie (Payer Analytics. AstraZeneca)
Kocks, Janwillem W.H. (University Medical Center Groningen)
Kupczyk, Maciej (Karolinska Institutet (Estocolm, Suècia))
Nuevo, Javier (Evidence Generation. AstraZeneca)
Plaza, Vicente (Institut d'Investigació Biomèdica Sant Pau)
Cabrera, Claudia (BioPharmaceuticals Medical (Evidence). AstraZeneca)
Raherison-Semjen, Chantal (Bordeaux University)
Walker, Brandie (University of Calgary)
Penz, Erika (University of Saskatchewan)
Gilbert, Ileen (Medical Affairs. AstraZeneca)
Lugogo, Njira Lucia (University of Michigan)
van der Valk, Ralf J.P. (Medical Affairs. AstraZeneca)
Fong, Andrew
Qian, Christina
Fabry-Vendrand, Caroline
Touboul, Chantal
Brzostek, Dorota
Maslova, Ekaterina
Surmont, Filip
Goike, Helena
Gandhi, Hitesh
Korevaar, J.C.
Tkacz, Joseph
Johnston, Karissa
Peres da Costa, Keith
van Dijk, L.
Vervloet, M.
Pollack, Michael
Hernandez, Paul
Boarino, S.
Noorduyn, Stephen G.
Beekman-Hendricks, Wendy
Weesie, Y.M.
Universitat Autònoma de Barcelona

Data:	2022
Resum:	Expert national/global asthma management recommendations raise the issue whether a safe threshold of short-acting beta-2 agonist (SABA) use without concomitant inhaled corticosteroids (ICS) exists. To examine SABA and maintenance therapy associations with severe asthma exacerbations across North America and Europe. Observational analyses of 10 SABa use IN Asthma (SABINA) datasets involving 1,033,564 patients (≥12 y) from Canada, France, the Netherlands, Poland, Spain, the United Kingdom, and the United States. Negative binomial models (incidence rate ratio [IRR] [95% CI adjusted for prespecified-covariates]) evaluated associations between SABA and exacerbations. Across severities, 40. 2% of patients were prescribed/possessed 3 or more SABA canisters/y. Per the Global Initiative for Asthma (GINA) 2018 definitions, steps 3 to 5-treated patients prescribed/possessing 3 or more versus 1 or 2 SABAs experienced more severe exacerbations (IRR 1. 08 [95% CI 1. 04‒1. 13], U. S. Medicare; IRR 2. 11 [95% CI 1. 96‒2. 27], Poland). This association was not observed in all step 1 or 2-treated patients (the Netherlands, IRR 1. 25 [95% CI 0. 91‒1. 71]; U. S. commercial, IRR 0. 92 [95% CI 0. 91‒0. 93]; U. S. Medicare, IRR 0. 74 [95% CI 0. 71‒0. 76]). We hypothesize that this inverse association between SABA and severe exacerbations in the U. S. datasets was attributable to the large patient population possessing fewer than 3 SABA and no maintenance therapy and receiving oral corticosteroid bursts without face-to-face health care provider encounters. In U. S. SABA monotherapy-treated patients, 3 or more SABAs were associated with more emergency/outpatient visits and hospitalizations (IRR 1. 31 [95% CI 1. 29‒1. 34]). Most GINA 2 to 5-treated study patients (60. 6%) did not have maintenance therapy for up to 50% of the time; however, the association of 3 or more SABAs and severe exacerbations persisted (IRR 1. 32 [95% CI 1. 18‒1. 49]) after excluding these patients and the independent effect was further confirmed when U. K. SABA data were analyzed as a continuous variable in patients with up to 100% annual coverage for ICS-containing medications. Increasing SABA exposure is associated with severe exacerbation risk, independent of maintenance therapy. As addressed by GINA, based on studies across asthma severities where as-needed fast-acting bronchodilators with concomitant ICS decrease severe exacerbations compared with SABA, our findings highlight the importance of avoiding a rescue/reliever paradigm utilizing SABA monotherapy.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Asthma ; Asthma management ; Inhaled corticosteroids ; Severe exacerbations ; Short-acting beta-2 agonists
Publicat a:	Journal of Allergy and Clinical Immunology: In Practice, Vol. 10 Núm. 9 (september 2022) , p. 2297-2309.e10, ISSN 2213-2198

DOI: 10.1016/j.jaip.2022.02.047
PMID: 35364341

23 p, 3.1 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats