Exacerbation Reduction in Patients With Asthma Following Initiation of Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) in the United States
Notice bibliographique
Résumé
Abstract Rationale: In the United States (US), up to 50% of patients with asthma remain uncontrolled despite adherence to inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) dual therapy, requiring escalation to triple therapy.Although the efficacy of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy has been demonstrated in clinical trials, real-world evidence on the clinical and economic benefits is sparse.This study evaluated the impact of FF/UMEC/VI on patients with asthma previously on ICS/LABA. Methods: This was a retrospective, longitudinal, pre-post claims study using Medicaid, commercial, and Medicare insurance data from the Komodo Health database. Data were collected from September 9, 2019, to December 31, 2023; the index date was the first pharmacy claim for FF/UMEC/VI. Eligible patients were adults with asthma with ≥12 months of continuous insurance coverage prior to and following the index date (pre- and post-initiation periods) who received ICS/LABA for ≥30 consecutive days during the pre-initiation period. Outcomes assessed included asthma-related exacerbations, oral corticosteroid (OCS) use, short-acting beta-agonist (SABA) use, asthma-related healthcare resource utilization (HRU, emergency department [ED] visits), and asthma-related medical costs. Odds/rate ratios (ORs/RRs; 95% confidence intervals [CIs]) of asthma-related exacerbations were compared pre-initiation versus post-initiation using logistic/Poisson regression models. OCS bursts, SABA canisters, and HRU were analyzed using Poisson regression models (RRs [95% CIs]); asthma-related medical costs were compared pre-initiation versus post-initiation using mean differences from generalized linear models. Results: Of 17,959 eligible patients, mean (standard deviation) age was 50.6 (14.1) and the majority were female (68.2%, n=12,240). Odds of any asthma-related exacerbations were significantly reduced by 52% post- versus pre-initiation (OR [95% CI]: 0.48 [0.46, 0.50], p<0.001); rates were reduced by 38% (RR [95% CI]: 0.62 [0.61, 0.64], p<0.001) (Figure). Rates of OCS bursts were 30% lower (RR [95% CI]: 0.70 [0.69, 0.72], p<0.001), SABA use 18% lower (RR [95% CI]: 0.82 [0.81, 0.83], p<0.001), asthma-related ED visits 39% lower (RR [95% CI]: 0.61 [0.58, 0.64], p<0.001) (Figure), and asthma-related medical costs 46% lower (mean difference [95% CI]: −$1115 [−$1771, −$459], p<0.001) post- versus pre-initiation. Conclusions: Significant reductions in asthma-related exacerbations, as well as lower OCS and SABA use, and reductions in asthma-related ED visits and medical costs were associated with the post-initiation period of FF/UMEC/VI treatment compared with the pre-initiation period. This provides novel, real-world evidence of the benefits of escalation to FF/UMEC/VI from ICS/LABA therapy in patients with asthma in the US, helping to inform treatment decisions in real-world clinical practice.
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 | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».