哮喘联盟

   摘要
   目的：国家哮喘治疗指南推荐使用低/中剂量吸入性皮质激素（ICS）作为轻度哮喘的初始治疗。然而，有时会同时联合使用低剂量固定剂量的ICS和长效β-受体激动剂。本试验比较采用准纳器吸入丙酸氟替卡松（100 μg）联合沙美特罗（50 μg）(FSC)与采用糠酸莫米松（MF）治疗的患者的哮喘相关转归和医疗资源使用和费用。
   方法：本试验为一项回顾性队列研究，通过对2004年1月至2008年12月间的大型健康保险索赔数据库进行分析，比较接受FSC和MF治疗的哮喘患者的哮喘相关转归。有≥1次索赔、有哮喘ICD-9-CM诊断编码和≥2 FSC或MF治疗的患者入选本研究，并基于首次采用的药物将患者分为FSC组和MF组，采用倾向得分对两组患者进行匹配。
   结果：共有18283名患者满足入选标准（FSC组14044人；MF组4239人）。共配对3799对（平均随访时间：FSC组548天；MF组537天）。FSC组患者哮喘发作（定义为哮喘相关急诊[ED]就诊/住院或接受全身皮质激素[SCSs]治疗）风险较低（危险比= 0.88；95% CI=0.81-0.95, p =0.002）、哮喘相关就医（PO）和门诊(HO)就诊次数较少（平均：1.17 vs. 1.63, p<0.001）。然而，FSC组患者哮喘相关ED就诊次数较多(p =0.004)，FSC组患者总的哮喘相关医疗费用增加（$953 vs. $862, p=0.002）。
   结论：在开始ICS治疗的哮喘患者中，MF治疗患者具有较少的哮喘相关ED就诊。然而，FSC能降低SCS的使用和哮喘相关PO/HO就诊。
 

（苏楠 审校）
J Asthma. 2013 Jan 10. [Epub ahead of print]

 

Risk of Asthma Exacerbation, Asthma-Related Health Care Utilization and Costs, and Adherence to Controller Therapy in Patients with Asthma Receiving Fluticasone Propionate/Salmeterol Inhalation Powder 100 μg/50 μg Versus Mometasone Furoate Inhalation Powder.
 
Hagiwara M, Delea TE, Stanford RH.

Source
(PAI) Policy Analysis Inc. , Brookline, MA , USA.

Abstract 
OBJECTIVE： National asthma treatment guidelines recommend low/medium-dose inhaled corticosteroids (ICSs) as initial therapy in mild asthma patients. However, low doses of a fixed-dose combination of ICS and long-acting β-agonists are sometimes used. This study compares asthma-related outcomes and health care utilization and costs in clinical practice in patients starting fluticasone propionate 100 μg and salmeterol 50 μg via Diskus (FSC) or mometasone furoate (MF).
METHODS.：A retrospective cohort study was conducted to compare asthma-related outcomes in asthma patients who received FSC or MF, using a large health insurance claims dataset spanning January 2004-December 2008. Patients with ≥1 claim with an asthma ICD-9-CM diagnosis code and ≥2 FSC or MF prescriptions were included, stratified into FSC or MF groups by study drug received first and matched using propensity score.
RESULTS：A total of 18,283 patients met inclusion criteria (14,044 FSC and 4239 MF); 3799 matched pairs were identified (mean follow-up: FSC 548 days, MF 537 days). FSC patients had lower risk of asthma-related exacerbation (Hazard ratio = 0.88, 95% CI 0.81-0.95, p = .002), defined as either asthma-related emergency department (ED) visits/hospitalizations or receipt of systemic corticosteroids (SCSs); fewer SCS claims (mean 0.28 vs. 0.33, p = .021); and fewer asthma-related physician office (PO) and hospital outpatient (HO) visits (mean 1.17 vs. 1.63, p < .001). However, asthma-related ED visits were higher with FSC (p = .004), and FSC patients had higher total costs of asthma-related health care ($953 vs. $862, p = .002).
CONCLUSIONS：In asthma patients initiating ICS therapy, MF had lower asthma-related ED visits. However, FSC may reduce the use of SCS and asthma-related PO/HO visits.

J Asthma. 2013 Jan 10. [Epub ahead of print]