Decreased Healthcare Utilization in Children With Severe Asthma 1-year After Biologics: An Interrupted Times Series Analysis
Notice bibliographique
Résumé
Abstract Rationale: In Canada, asthma is the most common chronic respiratory disease in children. Some children present with severe asthma, where they continue to experience symptoms such as poor sleep, school absenteeism and frequent exacerbations despite compliance with inhaled pharmacotherapy. An additional solution is the prescribed use of monoclonal antibody therapies (“biologics”) which target inflammatory mediators in patients with severe asthma. However, biologics are cost-prohibitive (∼$50,000 CAD/patient/year). Therefore, understanding the effectiveness of biologics on health outcomes and utilization in children with severe asthma will help identify the best populations for biologic use. Methods: A retrospective cohort study of children (6-18y) with severe asthma using biologics were identified using Observational Medical Outcomes Partnership (OMOP) Common Data Model system, a standardized data registry for electronic health records. Children using any combination of biologics (omalizumab [OM], mepolizumab [ME], or dupilumab [DU]), treated at the Hospital for Sick Children (Toronto) from May 2018 to March 2024 were included. Health outcomes (emergency department [ED] visits, hospitalizations, eosinophil count [EOS], lung function) were compared 1-year before and after initiation of biologics treatment. Logistic regressions were used to estimate odds ratios (OR) with 95% confidence intervals (CI) of asthma ED visits and hospitalizations. Interrupted time series (ITS) analysis was conducted to measure absolute effects of biologics. Results: A total of 7,178 children with asthma were identified, of whom 44 had severe asthma treated with biologics (OM = 30; DU =11; ME=3). The mean age (SD) was 13.3 (3.3) years and 21 (48%) were females. After biologics, inhaled and oral corticosteroids use decreased by 30.8% and 17.6%, respectively. ED visits per-patient year (PYR) declined from 0.88 to 0.06, with incidence rate ratio (IRR) of 14.0 (95% CI 4.47, 70.61). Asthma hospitalizations PYR also declined from 0.54 to 0.06, with IRR of 8.67 (95% CI 2.66, 44.74). The ITS analysis showed ED visits decreased from 3.0 to 0.2 before and after biologics, with absolute differences of -5.2 (95% CI -8, -2.4). Similarly, hospitalizations dropped from 2.0 to 0.2, with absolute differences of -2.4 (95% CI -4.3, -0.58). EOS was reduced from 535 to 399 cells/mcL, with absolute effect -329 (95% CI -254, -92). There were no statistical differences in pulmonary functions before and after biologics (Table 1). Conclusions: Asthma biologics significantly reduced acute healthcare utilization and EOS in children with severe asthma. Future studies need to evaluate the effects of biologics on patient-reported outcomes and when biologics may be weaned.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,004 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».