Effect of Individual Patient Characteristics and Treatment Choices on Reliever Medication Use in Moderate-Severe Asthma: A Poisson Analysis of Randomised Clinical Trials

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dc.contributor.authorvan Dijkman S.C.
dc.contributor.authorYorgancıoğlu A.
dc.contributor.authorPavord I.
dc.contributor.authorBrusselle G.
dc.contributor.authorPitrez P.M.
dc.contributor.authorOosterholt S.
dc.contributor.authorFumali S.
dc.contributor.authorMajumdar A.
dc.contributor.authorDella Pasqua O.
dc.date.accessioned2024-07-22T08:01:36Z
dc.date.available2024-07-22T08:01:36Z
dc.date.issued2024
dc.description.abstractIntroduction: Even though increased use of reliever medication, including short-acting beta agonists (SABA), provides an indirect measure of symptom worsening, there have been limited efforts to assess how different patterns of reliever use correlate with symptom control and future risk of exacerbations. Here, we evaluate the effect of individual baseline characteristics on reliever use in patients with moderate-severe asthma on regular maintenance therapy with fluticasone propionate (FP) or combination therapy with fluticasone propionate/salmeterol (FP/SAL) or budesonide/formoterol (BUD/FOR). Methods: A drug-disease model describing the number of 24-h puffs and overnight occasions was developed with data from five clinical studies (N = 6212). The model was implemented using a nonlinear mixed effects approach and a Poisson function, considering clinical and demographic baseline characteristics. Goodness of fit and model predictive performance were assessed. Heatmaps were created to summarise the effect of concurrent baseline factors on reliever utilisation. Results: The final model accurately described individual patterns of reliever use, which is significantly increased with time since diagnosis, smoking, higher Asthma Control Questionnaire (ACQ-5) score and higher body mass index (BMI) at baseline. Whilst the number of puffs decreases slowly after an initial drop relative to the start of treatment, exacerbating patients utilise significantly more reliever than those who do not exacerbate. The mean effect of FP/SAL (median dose: 250/50 μg BID) on reliever use was slightly higher than that of BUD/FOR (median dose: 160/4.5 μg BID), i.e. a 75.3% vs 69.3% reduction in reliever use, respectively. Conclusions: The availability of individual-level patient data in conjunction with a parametric approach enabled the characterisation of interindividual differences in the patterns of reliever use in patients with moderate-severe asthma. Taken together, individual demographic and clinical characteristics, as well as exacerbation history, can be considered an indicator of the degree of asthma control. High SABA reliever use suggests suboptimal clinical management of patients on maintenance therapy. © The Author(s) 2024.
dc.identifier.DOI-ID10.1007/s12325-023-02774-w
dc.identifier.issn0741238X
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/11510
dc.language.isoEnglish
dc.publisherAdis
dc.rightsAll Open Access; Hybrid Gold Open Access
dc.subjectAdministration, Inhalation
dc.subjectAdrenal Cortex Hormones
dc.subjectAnti-Asthmatic Agents
dc.subjectAsthma
dc.subjectBronchodilator Agents
dc.subjectBudesonide
dc.subjectBudesonide, Formoterol Fumarate Drug Combination
dc.subjectDrug Combinations
dc.subjectEthanolamines
dc.subjectFluticasone
dc.subjectFormoterol Fumarate
dc.subjectHumans
dc.subjectbudesonide plus formoterol
dc.subjectcorticosteroid
dc.subjectfluticasone propionate
dc.subjectfluticasone propionate plus salmeterol
dc.subjectsalbutamol
dc.subjectantiasthmatic agent
dc.subjectbronchodilating agent
dc.subjectbudesonide
dc.subjectbudesonide plus formoterol
dc.subjectethanolamine derivative
dc.subjectfluticasone
dc.subjectformoterol fumarate
dc.subjectadult
dc.subjectaged
dc.subjectArticle
dc.subjectAsthma Control Questionnaire
dc.subjectbody mass
dc.subjectclinical feature
dc.subjectcombination drug therapy
dc.subjectcontrolled study
dc.subjectcorticosteroid therapy
dc.subjectcurrent smoker
dc.subjectdemographics
dc.subjectdisease duration
dc.subjectdisease exacerbation
dc.subjectdose response
dc.subjectdrug choice
dc.subjectdrug dose titration
dc.subjectED50
dc.subjectex-smoker
dc.subjectfemale
dc.subjectforced expiratory volume
dc.subjecthealth care utilization
dc.subjecthuman
dc.subjecthysteresis
dc.subjectmaintenance therapy
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmaximum drug effect
dc.subjectmaximum permissible dose
dc.subjectmaximum possible effect
dc.subjectmoderate severe asthma
dc.subjectmoderate severe asthma
dc.subjectmonotherapy
dc.subjectpersonalized medicine
dc.subjectPoisson regression
dc.subjectrandomized controlled trial
dc.subjectrandomized controlled trial (topic)
dc.subjectsevere asthma
dc.subjectsingle drug dose
dc.subjectvalidation study
dc.subjectasthma
dc.subjectdrug combination
dc.subjectinhalational drug administration
dc.titleEffect of Individual Patient Characteristics and Treatment Choices on Reliever Medication Use in Moderate-Severe Asthma: A Poisson Analysis of Randomised Clinical Trials
dc.typeArticle

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