糠酸莫米松和丙酸氟替卡松治疗青少年和年轻成人哮喘的依从性和哮喘控制
2010/11/04
摘要
简介：青少年及年轻成人对哮喘控制药物的依从性较差，而这些药物是控制哮喘的关键，因此，有必要采取措施改善此类人群的药物依从性。方法之一是减少为控制哮喘每日用药的次数。通过干粉吸入器吸入糠酸莫米松（MF-DPI）是皮质激素吸入治疗（ICS）的一种形式，大部分哮喘患者采用每日一次进行哮喘控制。丙酸氟替卡松（FP）也属于吸入性激素，一般采用每日二次进行治疗。本项回顾性分析旨在青少年和年轻轻度哮喘患者中评价采用MF-DPI 或FP进行哮喘控制治疗的依从性和哮喘控制的标志物。
方法：对美国行政保险索赔数据库中约3700万患者的数据进行分析。2005年1月1日之2008年10月10日间，基于首次处方为MF-DPI 或 FP治疗，选取年龄为12～25岁、轻度哮喘、前期使用哮喘药物治疗的患者，并设定索引日期。收集索引日期前后365天内的人口统计学信息、治疗药物、健康资源利用数据。以索引日期前数据为基础，每个队列患者倾向评分为1:1。通过研究处方药物和药物使用天数（PDC）检测哮喘用药依从性。基于哮喘恶化和短效β2激动剂（SABA）使用情况检测哮喘控制。采用双变量和多变量广义线性模型（GLM）分析，研究不同队列间疾病转归的差异。
结果：患者匹配后，对每组各692名患者（平均年龄16岁）进行分析。MF-DPI组患者索引日期前依从性显著高于FP组患者，其PDC和处方药物分别为23.5% vs. 14.5% （p<0.0001）和2.70 vs. 1.91（p<0.0001）。MF-DPI组患者索引日期后，平均SABA使用次数显著低于FP组患者（1.04 vs. 1.40; p<0.0001）。索引日期后哮喘恶化次数两组间无显著差异。
结论：青少年/年轻成人轻度哮喘患者中，与FP治疗者相比，采用MF-DPI治疗者具有较好的索引日期后用药依从性，较少的SABA使用次数。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Adherence and asthma control with mometasone furoate versus fluticasone propionate in adolescents and young adults with mild asthma.
Friedman HS, Navaratnam P, McLaughlin J.
Analytic Solutions, LLC, New York, NY, USA.
Abstract
Introduction. Because adherence to asthma controller medication among adolescents and young adults is poor but critical for asthma control, strategies are needed to improve adherence. One strategy is to reduce the number of daily doses necessary to maintain adequate control. Mometasone furoate delivered through a dry powder inhaler (MF-DPI) is an inhaled corticosteroid (ICS) approved for once-daily dosing in most patients. Fluticasone propionate (FP) is an ICS approved for twice-daily dosing. A retrospective claims analysis was performed to assess treatment adherence and markers of asthma control in adolescent and young adult patients with mild asthma who began treatment with MF-DPI or FP.
Methods. Data from approximately 37 million patients in an administrative insurance claims database in the United States were analyzed. Patients, 12-25 years, with mild asthma and previous asthma medication use were assigned an index date based on their first prescription fill of MF-DPI or FP between 1 January 2005 and 10 October 2008. Demographics, prescription claims, and health care utilization data were captured in the 365-day period before (preindex) and after (postindex) the index date. Patients from each cohort were propensity score-matched 1:1 based on preindex data. Adherence was measured by prescription fills and percentage of days covered (PDC); asthma control was measured by exacerbations and short-acting β(2)-agonist (SABA) canister claims. Bivariate and multivariate generalized linear model (GLM) analyses were conducted to determine differences in outcomes between the cohorts.
Results. After matching, 692 patients per group (average age - 16 years) were analyzed. Adherence in the postindex period was significantly higher in the MF-DPI cohort compared with the FP cohort as measured by PDC (23.5% vs. 14.5%; p< .0001) and prescription fills (2.70 vs. 1.91; p< .0001). The mean number of postindex SABA canister claims was significantly lower in the MF-DPI cohort compared with the FP cohort (1.04 vs. 1.40; p< .0001). There was no significant difference in the mean number of postindex exacerbations between the cohorts.
Conclusion. Adolescent/young adult patients with mild asthma who received MF-DPI had better postindex adherence and fewer SABA canister claims than patients receiving FP.
J Asthma. 2010 Sep 13. [Epub ahead of print]
简介：青少年及年轻成人对哮喘控制药物的依从性较差，而这些药物是控制哮喘的关键，因此，有必要采取措施改善此类人群的药物依从性。方法之一是减少为控制哮喘每日用药的次数。通过干粉吸入器吸入糠酸莫米松（MF-DPI）是皮质激素吸入治疗（ICS）的一种形式，大部分哮喘患者采用每日一次进行哮喘控制。丙酸氟替卡松（FP）也属于吸入性激素，一般采用每日二次进行治疗。本项回顾性分析旨在青少年和年轻轻度哮喘患者中评价采用MF-DPI 或FP进行哮喘控制治疗的依从性和哮喘控制的标志物。
方法：对美国行政保险索赔数据库中约3700万患者的数据进行分析。2005年1月1日之2008年10月10日间，基于首次处方为MF-DPI 或 FP治疗，选取年龄为12～25岁、轻度哮喘、前期使用哮喘药物治疗的患者，并设定索引日期。收集索引日期前后365天内的人口统计学信息、治疗药物、健康资源利用数据。以索引日期前数据为基础，每个队列患者倾向评分为1:1。通过研究处方药物和药物使用天数（PDC）检测哮喘用药依从性。基于哮喘恶化和短效β2激动剂（SABA）使用情况检测哮喘控制。采用双变量和多变量广义线性模型（GLM）分析，研究不同队列间疾病转归的差异。
结果：患者匹配后，对每组各692名患者（平均年龄16岁）进行分析。MF-DPI组患者索引日期前依从性显著高于FP组患者，其PDC和处方药物分别为23.5% vs. 14.5% （p<0.0001）和2.70 vs. 1.91（p<0.0001）。MF-DPI组患者索引日期后，平均SABA使用次数显著低于FP组患者（1.04 vs. 1.40; p<0.0001）。索引日期后哮喘恶化次数两组间无显著差异。
结论：青少年/年轻成人轻度哮喘患者中，与FP治疗者相比，采用MF-DPI治疗者具有较好的索引日期后用药依从性，较少的SABA使用次数。
（陈欣 审校）
J Asthma. 2010 Sep 13. [Epub ahead of print]
Adherence and asthma control with mometasone furoate versus fluticasone propionate in adolescents and young adults with mild asthma.
Friedman HS, Navaratnam P, McLaughlin J.
Analytic Solutions, LLC, New York, NY, USA.
Abstract
Introduction. Because adherence to asthma controller medication among adolescents and young adults is poor but critical for asthma control, strategies are needed to improve adherence. One strategy is to reduce the number of daily doses necessary to maintain adequate control. Mometasone furoate delivered through a dry powder inhaler (MF-DPI) is an inhaled corticosteroid (ICS) approved for once-daily dosing in most patients. Fluticasone propionate (FP) is an ICS approved for twice-daily dosing. A retrospective claims analysis was performed to assess treatment adherence and markers of asthma control in adolescent and young adult patients with mild asthma who began treatment with MF-DPI or FP.
Methods. Data from approximately 37 million patients in an administrative insurance claims database in the United States were analyzed. Patients, 12-25 years, with mild asthma and previous asthma medication use were assigned an index date based on their first prescription fill of MF-DPI or FP between 1 January 2005 and 10 October 2008. Demographics, prescription claims, and health care utilization data were captured in the 365-day period before (preindex) and after (postindex) the index date. Patients from each cohort were propensity score-matched 1:1 based on preindex data. Adherence was measured by prescription fills and percentage of days covered (PDC); asthma control was measured by exacerbations and short-acting β(2)-agonist (SABA) canister claims. Bivariate and multivariate generalized linear model (GLM) analyses were conducted to determine differences in outcomes between the cohorts.
Results. After matching, 692 patients per group (average age - 16 years) were analyzed. Adherence in the postindex period was significantly higher in the MF-DPI cohort compared with the FP cohort as measured by PDC (23.5% vs. 14.5%; p< .0001) and prescription fills (2.70 vs. 1.91; p< .0001). The mean number of postindex SABA canister claims was significantly lower in the MF-DPI cohort compared with the FP cohort (1.04 vs. 1.40; p< .0001). There was no significant difference in the mean number of postindex exacerbations between the cohorts.
Conclusion. Adolescent/young adult patients with mild asthma who received MF-DPI had better postindex adherence and fewer SABA canister claims than patients receiving FP.
J Asthma. 2010 Sep 13. [Epub ahead of print]
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自我引导的运动能改善部分控制成人哮喘患者的健康感知
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针灸式经皮神经电刺激对儿童哮喘的影响
