描述间歇性口服皮质类固醇处方模式及其与哮喘不良结局的相关性的英国观察队列研究
2023/02/01
摘要
引言：口服皮质类固醇（OCS）治疗哮喘与发生不良后果的风险增加相关；以前的研究没有专门针对间歇性OCS的使用。
方法：这项历史（2008-2019）英国队列研究使用了两个匿名的真实数据库（OPCRD和CPRD）中的初级保健医疗记录，其中包括年龄≥4岁的哮喘患者，仅接受间歇性OCS治疗。患者根据其首次记录的哮喘间歇性OCS处方进行索引，并按OCS处方模式进行分类：一次性（单次）、较不频繁（≥90天间隔）和频繁（<90天间隔间隔）。非OCS患者的性别、年龄和索引日期为1:1，作为对照。采用多变量Cox比例风险模型，研究了OCS处方模式与OCS相关AO风险的关系，并根据年龄、全球哮喘倡议（GINA）2020治疗步骤以及指数前吸入皮质类固醇（ICS）和短效β2拮抗剂（SABA）处方进行分层。
结果：在476167名符合条件的患者中，分别有41.7%、26.8%和31.6%的患者具有一次性、较不频繁和频繁的间歇性OCS处方模式。随着间歇性OCS与非OCS模式的日益频繁，任何AO的风险增加（HR；95%可信区间：一次性1.19（1.18至1.20），不太频繁1.35（1.34至1.36），频繁1.42（1.42至1.43）），并且在年龄、GINA治疗步骤、ICS和SABA亚组之间一致。随着OCS日益频繁，个体OCS相关不良后果的最高风险是肺炎和睡眠呼吸暂停。
结论：在接受间歇性OCS治疗的哮喘患者中，相当比例的患者经历了频繁的处方模式。日益频繁的OCS处方模式与OCS相关不良后果的风险较高相关。需要采取缓解策略，以尽量减少初级护理中的间歇性OCS处方。
Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma
Heath Heatley, Trung N Tran, Arnaud Bourdin, Andrew Menzies-Gow, David J Jackson, Ekaterina Maslova, Jatin Chapaneri, Derek Skinner, Victoria Carter, Jeffrey Shi Kai Chan, Con Ariti, John Haughney, David B Price
Abstract
Introduction: Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (adverse outcomes); no previous study has focused exclusively on intermittent OCS use.
Methods: This historical (2008-2019) UK cohort study using primary care medical records from two anonymised, real-life databases (OPCRD and CPRD) included patients aged≥4 years with asthma receiving only intermittent OCS. Patients were indexed on their first recorded intermittent OCS prescription for asthma and categorised by OCS prescribing patterns: one-off (single), less frequent (≥90 day gap) and frequent (<90 day gap). Non-OCS patients matched 1:1 on gender, age and index date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, Global Initiative for Asthma (GINA) 2020 treatment step, and pre index inhaled corticosteroid (ICS) and short-acting β2-agonist (SABA) prescriptions using a multivariable Cox-proportional hazard model.
Findings: Of 476 167 eligible patients, 41.7%, 26.8% and 31.6% had one-off, less frequent and frequent intermittent OCS prescribing patterns, respectively. Risk of any AO increased with increasingly frequent patterns of intermittent OCS versus non-OCS (HR; 95% CI: one-off 1.19 (1.18 to 1.20), less frequent 1.35 (1.34 to 1.36), frequent 1.42 (1.42 to 1.43)), and was consistent across age, GINA treatment step and ICS and SABA subgroups. The highest risks of individual OCS-related adverse outcomes with increasingly frequent OCS were for pneumonia and sleep apnoea.
Conclusion: A considerable proportion of patients with asthma receiving intermittent OCS experienced a frequent prescribing pattern. Increasingly frequent OCS prescribing patterns were associated with higher risk of OCS-related adverse outcomes. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.
引言：口服皮质类固醇（OCS）治疗哮喘与发生不良后果的风险增加相关；以前的研究没有专门针对间歇性OCS的使用。
方法：这项历史（2008-2019）英国队列研究使用了两个匿名的真实数据库（OPCRD和CPRD）中的初级保健医疗记录，其中包括年龄≥4岁的哮喘患者，仅接受间歇性OCS治疗。患者根据其首次记录的哮喘间歇性OCS处方进行索引，并按OCS处方模式进行分类：一次性（单次）、较不频繁（≥90天间隔）和频繁（<90天间隔间隔）。非OCS患者的性别、年龄和索引日期为1:1，作为对照。采用多变量Cox比例风险模型，研究了OCS处方模式与OCS相关AO风险的关系，并根据年龄、全球哮喘倡议（GINA）2020治疗步骤以及指数前吸入皮质类固醇（ICS）和短效β2拮抗剂（SABA）处方进行分层。
结果：在476167名符合条件的患者中，分别有41.7%、26.8%和31.6%的患者具有一次性、较不频繁和频繁的间歇性OCS处方模式。随着间歇性OCS与非OCS模式的日益频繁，任何AO的风险增加（HR；95%可信区间：一次性1.19（1.18至1.20），不太频繁1.35（1.34至1.36），频繁1.42（1.42至1.43）），并且在年龄、GINA治疗步骤、ICS和SABA亚组之间一致。随着OCS日益频繁，个体OCS相关不良后果的最高风险是肺炎和睡眠呼吸暂停。
结论：在接受间歇性OCS治疗的哮喘患者中，相当比例的患者经历了频繁的处方模式。日益频繁的OCS处方模式与OCS相关不良后果的风险较高相关。需要采取缓解策略，以尽量减少初级护理中的间歇性OCS处方。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Thorax. 2022 Dec 27; thorax-2022-219642. doi: 10.1136/thorax-2022-219642.)
(Thorax. 2022 Dec 27; thorax-2022-219642. doi: 10.1136/thorax-2022-219642.)
Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma
Heath Heatley, Trung N Tran, Arnaud Bourdin, Andrew Menzies-Gow, David J Jackson, Ekaterina Maslova, Jatin Chapaneri, Derek Skinner, Victoria Carter, Jeffrey Shi Kai Chan, Con Ariti, John Haughney, David B Price
Abstract
Introduction: Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (adverse outcomes); no previous study has focused exclusively on intermittent OCS use.
Methods: This historical (2008-2019) UK cohort study using primary care medical records from two anonymised, real-life databases (OPCRD and CPRD) included patients aged≥4 years with asthma receiving only intermittent OCS. Patients were indexed on their first recorded intermittent OCS prescription for asthma and categorised by OCS prescribing patterns: one-off (single), less frequent (≥90 day gap) and frequent (<90 day gap). Non-OCS patients matched 1:1 on gender, age and index date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, Global Initiative for Asthma (GINA) 2020 treatment step, and pre index inhaled corticosteroid (ICS) and short-acting β2-agonist (SABA) prescriptions using a multivariable Cox-proportional hazard model.
Findings: Of 476 167 eligible patients, 41.7%, 26.8% and 31.6% had one-off, less frequent and frequent intermittent OCS prescribing patterns, respectively. Risk of any AO increased with increasingly frequent patterns of intermittent OCS versus non-OCS (HR; 95% CI: one-off 1.19 (1.18 to 1.20), less frequent 1.35 (1.34 to 1.36), frequent 1.42 (1.42 to 1.43)), and was consistent across age, GINA treatment step and ICS and SABA subgroups. The highest risks of individual OCS-related adverse outcomes with increasingly frequent OCS were for pneumonia and sleep apnoea.
Conclusion: A considerable proportion of patients with asthma receiving intermittent OCS experienced a frequent prescribing pattern. Increasingly frequent OCS prescribing patterns were associated with higher risk of OCS-related adverse outcomes. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.
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Elarekibep(PRS-060/AZD1402)：以IL-4ra为靶点治疗T2内型哮喘的新型吸入型抗哮喘药物
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非控制性或口服皮质类固醇依赖性过敏性和非过敏性哮喘患者的度普利尤单抗疗效
