Add-on tiotropium versus step-up inhaled corticosteroid plus long-acting beta-2‐agonist in real-world patients with asthma

2020 ◽  
Vol 41 (4) ◽  
pp. 248-255
Author(s):  
Bradley Chipps ◽  
Giselle Mosnaim ◽  
Sameer K. Mathur ◽  
Asif Shaikh ◽  
Samir Khoury ◽  
...  
Keyword(s):  
Real World ◽  
Index Date ◽  
Group Versus ◽  
Group Index ◽  
Inhaled Corticosteroid ◽  
Ed Visits ◽  
Exacerbation Risk ◽  
Beta 2 ◽  
Long Acting ◽  
The Impact

Background: A step-up approach (increasing inhaled corticosteroid [ICS] dose and/or add-on treatment) is recommended for asthma that is uncontrolled despite ICS plus long-acting beta-2‐agonist (LABA) combination treatment. Understanding the impact of different treatment options on health outcomes can help guide treatment decision-making. Objective: To compare the effectiveness of add-on tiotropium 1.25 µg (two puffs once daily) versus an increased ICS plus LABA dose in a real-world cohort of patients with asthma initiated on ICS plus LABA. Methods: De-identified data from patients ages ≥12 years and with asthma who were initiated on ICS plus LABA, and then had tiotropium added (Tio group; index date) or an ICS plus LABA dose increased (inc-ICS group; index date) were collected from two medical and pharmacy claims data bases (2014‐2018). To account for population/group differences, propensity score matching was performed. The primary end point was the exacerbation risk after the index date. Secondary end points included exacerbation rates 6 and 12 months postindex, health-care resource utilization, costs, and short-acting beta-2‐agonist (SABA) refills 12 months postindex. Results: Overall, 7857 patients (Tio group, 2619; inc-ICS group, 5238) were included. The exacerbation risk was 35% lower in the Tio group than in the inc-ICS group (hazard ratio 0.65 [95% confidence interval, 0.43‐0.99]; p = 0.044). Exacerbation rates in the Tio group also were significantly lower within 6 and 12 months postindex (64% and 73%, respectively). All-cause and asthma-related emergency department (ED) visits were 47% and 74% lower, respectively (p < 0.0001 for both), and all-cause and asthma-related hospitalizations were 48% (p < 0.01) and 76% (p < 0.001) lower, respectively, in the Tio group. Also, significantly fewer patients in the Tio group versus the inc-ICS group required SABA refills (56% versus 67%, p < 0.0001). Conclusion: Add-on tiotropium significantly decreased the risk and rate of exacerbations, decreased all-cause and asthma-related ED visits and hospitalizations, and reduced SABA refills compared with increasing the ICS plus LABA dose. The findings supported the use of add-on tiotropium for patients with uncontrolled asthma taking ICS plus LABA.

scholarly journals Real-world effectiveness of long-acting antipsychotic treatments in a nationwide cohort of 3957 patients with schizophrenia, schizoaffective disorder and other diagnoses in Quebec

2018 ◽  
Vol 8 (11) ◽  
pp. 287-301 ◽  
Author(s):  
Emmanuel Stip ◽  
Jean Lachaine
Keyword(s):  
Real World ◽  
Index Date ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Healthcare Resource Utilization ◽  
Universal Healthcare ◽  
Medication Costs ◽  
Healthcare Program ◽  
Long Acting ◽  
The Impact

Background: Long-acting injectable antipsychotics (LAI-AP) for patients with schizophrenia (SCZ) have saved significant healthcare costs. However, the cost effectiveness of LAI-AP for patients with other mental disorders has yet to be established. The goal of this study was to evaluate the impact of early initiation of LAI-AP medications on healthcare resource utilization (HRU). Drawing on the Quebecois universal healthcare program (RAMQ), we conducted a nationwide prospective cohort study of LAI-AP under real-world conditions. Methods: This study was performed using a representative sample of patients newly treated with LAI-AP ( n = 3957) who were covered by the Québec Health Insurance Plan. The index date was defined as the date of the first prescription for LAI-AP between 1 January 2008 and 31 March 2012. We collected (a) the demographics and patient characteristics; (b) the treatment characteristics index drug, speciality of the principal prescriber, prescriptions of LAI-AP; and (c) HRU and costs. Two comparisons were made between (a) non-SCZ users of LAI-AP and SCZ users of LAI-AP; and (b) patients with SCZ using first-generation antipsychotic LAI-AP (FGA-LAI) and second-generation antipsychotic LAI-AP (SGA-LAI). Results: In the people with SCZ group, 976 patients were on an SGA-LAI, and 1020 patients were on an FGA-LAI; 41.9% of all users were on risperidone LAI-AP during this period and 17.9% were on zuclopenthixol decanoate. The number of hospitalizations was reduced by half. Durations were also significantly reduced. The total healthcare cost savings for all users were C$29,876 per patient/per year. Younger patients tended to receive more SGA-LAI than FGA-LAI: 29% versus 13%. The percentage of general practitioners who prescribe LAI-AP is higher in the FGA-LAI group than in the SGA-LAI group: 19% versus 13%. For psychiatrist prescribers, it is the opposite: 86% (SGA-LAI) versus 79% (FGA-LAI). The concomitant use of oral antipsychotics (OAP) in the year following index date is higher in the FGA-LAI group: 75% versus 43%. The number of hospitalization days was reduced by 31.5 days in the FGA-LAI group and 38.8 days in the SGA-LAI group. Cost savings were of C$31,924 in the FGA-LAI group and of C$39,100 in the SGA-LAI group. Conclusion: The initiation of LAI-AP saved significant costs to the province of Québec compared with the previous year. Initiation of a LAI-AP resulted in lower resource use. Higher medication costs were offset by lower inpatient and outpatient costs.

scholarly journals Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

2021 ◽  
Vol 8 (1) ◽  
pp. e000840
Author(s):  
Lianne Parkin ◽  
Sheila Williams ◽  
David Barson ◽  
Katrina Sharples ◽  
Simon Horsburgh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Real World ◽  
Chronic Obstructive ◽  
Treatment Intensification ◽  
Cardiovascular Comorbidity ◽  
Coronary Syndrome ◽  
Long Acting ◽  
The Impact

BackgroundCardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case–control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.MethodsWe used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.ResultsFrom the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).ConclusionIn real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.

Assessment of anti-inflammatory effect from addition of a long-acting beta-2 agonist to inhaled corticosteroid

2016 ◽  
Vol 37 (5) ◽  
pp. 387-393 ◽  
Author(s):  
Terufumi Shimoda ◽  
Yasushi Obase ◽  
Reiko Kishikawa ◽  
Hiroshi Mukae ◽  
Tomoaki Iwanaga
Keyword(s):  
Inhaled Corticosteroid ◽  
Beta 2 ◽  
Anti Inflammatory ◽  
Long Acting ◽  
Inflammatory Effect

scholarly journals Could Patients with Multiple Myeloma (MM) Derive Additional Benefit from Their Treatments? Real-World Evidence for Carfilzomib Dosing Intensity on Survival and Treatment Progression

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 836-836 ◽  
Author(s):  
Rohan Medhekar ◽  
Dionne Hines ◽  
Sumeet Panjabi ◽  
Tim Welliver ◽  
Xin Wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Lower Risk ◽  
Index Date ◽  
Cox Model ◽  
Weekly Dose ◽  
Employment Equity ◽  
K Index ◽  
Equity Ownership ◽  
The Impact

Abstract Introduction: Carfilzomib (K) was first approved in 2012 for the treatment of relapsed/refractory multiple myeloma (RRMM) at a dose of 27 mg/m2 twice weekly (27 BIW). The K dose has since been optimized; carfilzomib plus dexamethasone (Kd) is approved for patients with RRMM at a recommended K dose of 56 mg/m2 twice weekly (56 BIW) since 2016. Recently, the A.R.R.O.W trial showed that Kd 70mg/m2 once weekly (70 QW) significantly improved progression free survival compared to Kd 27 BIW. Considering the study time-period, however, patients are still treated with 27 BIW in the real-world leaving them possibly under-treated. The Kd 27 BIW, corresponds to a cumulative weekly dose (CWD) of K <120mg, while both Kd 56 BIW and Kd 70 QW (optimized dose-56 BIW/70 QW) correspond to a CWD of K >120mg. Therefore, in order to understand the relationship between dose and outcomes we examined the impact of K-dosing (CWD >120mg [optimized dose-56 BIW/70 QW] vs. CWD ≤120 mg [27 BIW]) on time to next treatment (TTNT) and overall survival (OS) among patients treated with Kd regimen. Methods: IQVIA's Oncology Electronic Medical Records database was used to identify patients ≥18 years of age, with a diagnosis of MM between 1/1/2010 and 10/31/2017, receiving Kd regimen in any line of therapy, with ≥ 3 doses of K on or after their K-index date (first administration of K in the Kd regimen, between 1/1/2013 and 10/31/2017). Patients were required to have ≥ 3 doses of K in order to establish continuity and for calculating CWD. CWD was calculated as the cumulative sum of weekly dose of K received by the patient divided by the number of weeks with Kd administration. The first two K doses were excluded from the calculation of CWD as these represent the loading dose. OS and TTNT were compared between patients receiving optimized dose-56 BIW/70 QW vs. 27 BIW. OS was evaluated among the subset of patients with a recorded deceased or alive status and measured from the K-index date until death due to any cause or the end of the study period, where they were censored. TTNT was defined as the time from initiation of the Kd regimen until the start of a subsequent regimen that did not contain Kd (treatment progression). Additionally, a landmark analysis at 12 months from initiation of Kd regimen was conducted to measure the proportion of patients alive and the proportion of patients with treatment progression. Kaplan-Meier analysis was used to estimate OS and TTNT and the log-rank test was used to compare the groups. Adjusted hazard ratios for OS and TTNT were evaluated using Cox models. Results : A total of 1,469 eligible MM patients with ≥3 Kd administrations were identified, of which 129 (8.8%; mean age: 63.5, SD: 9.8) received optimized dose-56 BIW/70 QW and 1,340 (91.2%; mean age: 67.0, SD: 10.4) received 27 BIW. The median follow-up time was slightly over a year for patients in both cohorts. The median K dose was 147.0 mg among patients in optimized dose-56 BIW/70 QW group and 88.1 mg among patients in 27 BIW group. Median OS was not estimable (NE), however, OS for the optimized dose-56 BIW/70 QW group (n=78) was significantly longer than that of the 27 BIW group (n=771; p=0.002) (Fig. 1). The proportion of patients in optimized dose-56 BIW/70 QW group alive at 12 months was 90.3% compared to 79.7% for patients in 27 BIW group respectively. Covariate-adjusted cox model showed that patients in optimized dose-56 BIW/70 QW group had a 64% lower risk of death than patients in 27 BIW group (adjusted HR: 0.364; 95% CI: 0.178-0.745; p = 0.0057, Table 1). TTNT was significantly longer for patients in optimized dose-56 BIW/70 QW group compared to patients in 27 BIW group (p=0.023; median TTNT: 17.5 [95% CI: 14.8-NE] and 13.2, [95% CI: 12.4-14.4], respectively) (Fig. 2). Covariate-adjusted cox model showed that patients in optimized dose-56 BIW/70 QW group had a 33% lower risk of treatment progression than patients in 27 BIW group (adjusted HR: 0.669; 95% CI: 0.483-0.927; p=0.0155, Table 1). Conclusion: Among patients treated with Kd regimen, a smaller proportion were prescribed K at optimized dose-56 BIW/70 QW. Patients receiving the optimized dose-56 BIW/70 QW had significantly improved OS and TTNT compared to those receiving 27 BIW. Our findings suggest that these patient-relevant outcomes may be improved in a vast majority of RRMM patients currently under-treated with carfilzomib by optimizing the dose, taking into consideration patients' comorbidities and ability to tolerate therapy. Disclosures Medhekar: Amgen: Employment, Equity Ownership. Hines:Amgen: Consultancy. Panjabi:Amgen: Employment, Equity Ownership. Welliver:Amgen: Employment, Equity Ownership. Wang:Amgen: Consultancy. Wade:Amgen: Consultancy.

Real-world effects of two inhaled corticosteroid/long-acting β2-agonist combinations in the treatment of asthma

2014 ◽  
Vol 51 (7) ◽  
pp. 762-768 ◽  
Author(s):  
Kazuhiro Yatera ◽  
Kei Yamasaki ◽  
Chinatsu Nishida ◽  
Shingo Noguchi ◽  
Keishi Oda ◽  
...  
Keyword(s):  
Real World ◽  
Inhaled Corticosteroid ◽  
Long Acting ◽  
Β2 Agonist
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