哮喘联盟

   摘要
   背景：基于临床试验结果，吸入糖皮质激素(ICS)是预防哮喘相关急性发作最有效的控制药物，然而很少有研究在现实生活人群中评估ICS的比较疗效。
   目的：明确哮喘儿童在初始使用了下列控制药物治疗后哮喘急性发作的可能性：ICS、白三烯受体拮抗剂(LTRA)、以及ICS与长效β2受体激动剂(LABA)联合治疗。
   方法：本研究为一项回顾性队列研究，纳入受试者来自哮喘和肺部疾病网络中基于人群有效性的一部分。通过校正基线协变量、依从使用药物的天数比例和高维倾向得分进行Cox回归分析。主要结果评估为急诊就诊、住院治疗或口服糖皮质激素的使用。
   结果：共纳入15567例健康计划受试者以及10624例TennCare医疗补助的哮喘未控制者。总体哮喘控制药物的使用依从性较低，在初始补充了药物后只有不超过50%的受试者再补充药物。对于过敏性鼻炎受试者，TennCare医疗救助者中，与接收ICS治疗者相比，LTRAs治疗者具有较小的ED就诊可能性(风险比0.44 [95% CI, 0.21-0.93])。对于所有其他组受试者，接收LTRA或ICS-LAB治疗的受试者与ICS治疗者具有相同的ED就诊、住院治疗或需要口服糖皮质激素的可能性。
   结论：哮喘相关急性发作风险在初始接受LTRA与ICS治疗的儿童间无差异，对此结果的解释可能是在由适应症或其它不可测因素引起的残余混杂因素的现实生活使用中LTRA与ICS具有相似的疗效。
 

（林江涛 审校）
JAllergyClinImmunolPract.2014Sep-Oct;2(5):607-13.doi:10.1016/j.jaip.2014.05.009. Epub 2014 Jul 25.


 

Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.
 

Wu AC1, Li L2, Fung V3, Kharbanda EO4, Larkin EK5, Vollmer WM6, Butler MG7, Miroshnik I2, Rusinak D2, Davis RL7, Hartert T5, Weiss ST8, Lieu TA9.
 

ABSTRACT
BACKGROUND: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS.
OBJECTIVE: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy.
METHODS: This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use.
RESULTS: Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS.
CONCLUSION: Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.
 

JAllergyClinImmunolPract.2014Sep-Oct;2(5):607-13.doi:10.1016/j.jaip.2014.05.009. Epub 2014 Jul 25.