Treatment choice for adult patients with moderate-to-severe asthma – The TAILOR study
Jeannetot D., de Ridder M., Mosseveld M., Pedersen L., Lapi F., Marconi E., Tan EH., Delmestri A., Prieto-Alhambra D., Van Der Deijl M., Brusselle G., Verhamme K.
BackgroundIn patients with uncontrolled asthma treated with medium dose (md) inhaled corticosteroid/long-acting beta2 agonist (ICS/LABA), The Global Initiative for Asthma (GINA) recommends to increase to high dose (hd) ICS/LABA or to start therapy consisting of md ICS/LABA+LAMA (long-acting muscarinic antagonist). Adding LAMA on top of hd ICS/LABA is not recommended for Step 4 asthma patients, yet it is used in the real world. Patient characteristics influencing treatment step-up are unknown.ObjectivesIdentify determinants of step-up option (hd ICS/LABA, md ICS/LABA+LAMA, hd ICS/LABA+LAMA) in patients with moderate to severe asthma.MethodsA retrospective cohort study using three primary care databases (IPCI, HSD, CPRD GOLD) and one prescription database (Aarhus) included asthma patients with step-up after≥3 months use of md ICS/LABA, from January 2010 to April 2020. Characteristics of patients were described and determinants of choice for md ICS/LABA+LAMA or high dose ICS/LABA were investigated.Results492 639 adults with asthma and≥1 year of database history were identified and 25 558 were eligible for analysis. 6126 patients stepped-up to md ICS/LABA+LAMA and 18 947 patients stepped-up to hd ICS/LABA. Determinants for step-up to md ICS/LABA+LAMA were higher age and presence of COPD whereas history of atopy lowered this choice. Other covariates were differentially associated with specific treatment step-up depending on the databases.ConclusionIn uncontrolled asthma patients on md ICS/LABA, treatment step-up with add-on LAMA was more likely than step-up to hd ICS/LABA in older patients, current smokers, with a history of asthma exacerbations and concomitant diagnosis of COPD.