Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

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Author
Postma, Dirkje S.
Dekhuijzen, Richard
van der Molen, Thys
Martin, Richard J.
van Aalderen, Wim
Roche, Nicolas
Guilbert, Theresa W.
van Eickels, Daniela
Khalid, Javaria Mona
Herings, Ron M.C.
Overbeek, Jetty A.
Miglio, Cristiana
Thomas, Victoria
Hutton, Catherine
Hillyer, Elizabeth V.
Price, David B.
Note: Order does not necessarily reflect citation order of authors.
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https://doi.org/10.4168/aair.2017.9.2.116Metadata
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Postma, D. S., R. Dekhuijzen, T. van der Molen, R. J. Martin, W. van Aalderen, N. Roche, T. W. Guilbert, et al. 2017. “Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids.” Allergy, Asthma & Immunology Research 9 (2): 116-125. doi:10.4168/aair.2017.9.2.116. http://dx.doi.org/10.4168/aair.2017.9.2.116.Abstract
Purpose Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). Methods: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. Results: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. Conclusions: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266109/pdf/Terms of Use
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