法国、德国、意大利和英国的哮喘患者口服皮质类固醇处方模式
2020/04/07
摘要
口服皮质类固醇（OCS）用于治疗哮喘急性发作和严重、无法控制的哮喘，但使用OCS会引起不良反应。我们旨在描述西欧哮喘患者的实际管理中OCS的使用方式。我们使用了2011年7月至2018年2月来自法国、德国、意大利和英国的数据库中的电子病历。12岁以上且有哮喘诊断的患者、约6个月内诊断哮喘且使用1种以上非OCS哮喘药物以及入组前≥6个月和入组后≥90天的可用数据被纳入。高OCS使用被定义为在随访期间90天之内处方OCS≥450mg。随访期间的基线特征和OCS使用情况通过总体特征和OCS使用状态表示。在702685名哮喘患者中，随访期同一时间OCS使用者为14-44％和OCS高使用者为6-9％。所有国家高OCS使用每年约为3％。高OCS使用者平均每年有1-3次OCS处方，平均每日OCS剂量为1.3-2.2 mg。对于持续使用高剂量OCS的患者，每天OCS使用至少两年稳定在5.5-7.5 mg，这增加了不良反应的风险。我们的研究表明，在四个研究的欧洲国家中OCS的使用相对普遍。这项研究的数据可能会提供决定性的临床见解，为参与严重、不受控制的哮喘治疗的基层医疗医生和专家提供信息。
Oral Corticosteroid Prescription Patterns for Asthma in France, Germany, Italy, and the United Kingdom.
Trung N Tran, Elizabeth King, Rajiv Sarkar, Cassandra Nan, Annalisa Rubino, Caroline O'Leary, Ruvimbo Muzwidzwa, Laura Belton, Jennifer K Quint.
Abstract
Oral corticosteroids (OCS) are used to manage asthma exacerbations and severe, uncontrolled asthma, but OCS use is associated with adverse effects. We aimed to describe the patterns of OCS use in the real-world management of patients with asthma in western Europe.We used electronic medical records from databases in France, Germany, Italy, and the United Kingdom from July 2011 through February 2018. Patients aged ≥12 years with an asthma diagnosis, ≥1 non-OCS asthma medication within ±6 months of diagnosis, and available data ≥6 months prior to and ≥90 days after cohort entry were included. High OCS use was defined as OCS ≥450 mg prescribed in a 90-day window during follow-up. Baseline characteristics and OCS use during follow-up were described overall and by OCS use status.Of 702 685 patients with asthma, 14-44% were OCS users and 6-9% were high OCS users at some point during follow-up. Annual prevalence of high OCS use across all countries was approximately 3%. High OCS users had a mean 1-3 annual OCS prescriptions, with an average daily OCS dosage of 1.3-2.2 mg. For patients who continued to meet the high use definition, daily OCS exposure was generally stable at 5.5-7.5 mg for at least 2 years, increasing the risk of adverse effects.Our study demonstrates that OCS use is relatively common across the four studied European countries. Data from this study may provide decisive clinical insights to inform primary care physicians and specialists involved in the management of severe, uncontrolled asthma.
口服皮质类固醇（OCS）用于治疗哮喘急性发作和严重、无法控制的哮喘，但使用OCS会引起不良反应。我们旨在描述西欧哮喘患者的实际管理中OCS的使用方式。我们使用了2011年7月至2018年2月来自法国、德国、意大利和英国的数据库中的电子病历。12岁以上且有哮喘诊断的患者、约6个月内诊断哮喘且使用1种以上非OCS哮喘药物以及入组前≥6个月和入组后≥90天的可用数据被纳入。高OCS使用被定义为在随访期间90天之内处方OCS≥450mg。随访期间的基线特征和OCS使用情况通过总体特征和OCS使用状态表示。在702685名哮喘患者中，随访期同一时间OCS使用者为14-44％和OCS高使用者为6-9％。所有国家高OCS使用每年约为3％。高OCS使用者平均每年有1-3次OCS处方，平均每日OCS剂量为1.3-2.2 mg。对于持续使用高剂量OCS的患者，每天OCS使用至少两年稳定在5.5-7.5 mg，这增加了不良反应的风险。我们的研究表明，在四个研究的欧洲国家中OCS的使用相对普遍。这项研究的数据可能会提供决定性的临床见解，为参与严重、不受控制的哮喘治疗的基层医疗医生和专家提供信息。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Eur Respir J (IF: 11.807) 2020 Mar 12. PMID: 32165402 DOI: 10.1183/13993003.02363-2019.)
(Eur Respir J (IF: 11.807) 2020 Mar 12. PMID: 32165402 DOI: 10.1183/13993003.02363-2019.)
Oral Corticosteroid Prescription Patterns for Asthma in France, Germany, Italy, and the United Kingdom.
Trung N Tran, Elizabeth King, Rajiv Sarkar, Cassandra Nan, Annalisa Rubino, Caroline O'Leary, Ruvimbo Muzwidzwa, Laura Belton, Jennifer K Quint.
Abstract
Oral corticosteroids (OCS) are used to manage asthma exacerbations and severe, uncontrolled asthma, but OCS use is associated with adverse effects. We aimed to describe the patterns of OCS use in the real-world management of patients with asthma in western Europe.We used electronic medical records from databases in France, Germany, Italy, and the United Kingdom from July 2011 through February 2018. Patients aged ≥12 years with an asthma diagnosis, ≥1 non-OCS asthma medication within ±6 months of diagnosis, and available data ≥6 months prior to and ≥90 days after cohort entry were included. High OCS use was defined as OCS ≥450 mg prescribed in a 90-day window during follow-up. Baseline characteristics and OCS use during follow-up were described overall and by OCS use status.Of 702 685 patients with asthma, 14-44% were OCS users and 6-9% were high OCS users at some point during follow-up. Annual prevalence of high OCS use across all countries was approximately 3%. High OCS users had a mean 1-3 annual OCS prescriptions, with an average daily OCS dosage of 1.3-2.2 mg. For patients who continued to meet the high use definition, daily OCS exposure was generally stable at 5.5-7.5 mg for at least 2 years, increasing the risk of adverse effects.Our study demonstrates that OCS use is relatively common across the four studied European countries. Data from this study may provide decisive clinical insights to inform primary care physicians and specialists involved in the management of severe, uncontrolled asthma.
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