Table 3.
General OCS and SCS Use for Patients with Asthma, Categorized by Disease Severity
| Source | Sample Size | OCS or SCS Use at Follow-Up/Postindex, % (n/N) | OCS or SCS Use at Baseline/Preindex, % (n/N) |
|---|---|---|---|
| Any degree of asthma severity | |||
| Afshar et al., 2017 (130) (U.S.) | 14,012 (all individuals) | OCS | — |
| Asthma prevalence: 7.4% | 8.8 (95% CI, 6.2–11.3) | ||
| Arellano et al., 2011 (79) (U.S.) | 6–18 yr: 659,169 | OCS | — |
| 6–11 yr: 348,991 | 6–18 yr: 25.2 (165,783/659,169) | ||
| 6–11 yr: 27.6 (103,292/374,068) | |||
| Black et al., 2012 (80) (U.S.) | 74,057 | — | OCS |
| 31.2 | |||
| (23,115/74,057) | |||
| Björnsdóttir et al., 2014 (131) (Iceland) | 6,142 | — | OCS |
| 12.7 (783/6,142) | |||
| Butler et al., 2016 (132) (U.S.) | 123,868 | OCS | — |
| Jan 2005: 7.3% | |||
| Choi et al., 2017 (133) (South Korea) | 831,613 | OCS | — |
| 40.61 | |||
| Cooper et al., 2015 (134) (UK) | 2,624 | OCS | — |
| 12.0 (314/2,624) | |||
| Delate et al., 2017 (135) (U.S.) | 2,360 | SCS | SCS |
| 30.6 (723/2,360) | 35.8 (845/2,360) | ||
| P < 0.001 vs. preintervention | — | ||
| Farber et al., 2017 (81) (U.S.) | 5–8 yr: 20,645 | OCS | — |
| 9–12 yr: 14,716 | Rx (2,015) | ||
| 13–17 yr: 11,142 | 5–8 yr (N = 20,645) | ||
| 1: 31.9 (6,580) | |||
| 2: 6.6 (1,371) | |||
| ≥3: 3.5 (720) | |||
| 9–12 yr (N = 14,716) | |||
| 1: 28.2 (4,143) | |||
| 2: 5.3 (781) | |||
| ≥3: 2.2 (317) | |||
| 13–17 yr (N = 11,142) | |||
| 1: 30.1 (3,357) | |||
| 2: 4.3 (484) | |||
| ≥3: 2.4 (269) | |||
| Iribarren et al., 2012 (82) (U.S.) | 203,595 | — | OCS |
| 20% | |||
| Laforest et al., 2015 (136) (France) | UK: 38,637 | SCS | — |
| Non: 6,996 Low: 14,903 High: 16,738 |
Non/low/high ICS* | ||
| UK: 6.2%/22.5%/12.7% | |||
| France: 4,587 | P < 0.0001 | ||
| Non: 1,176 Low: 1,358 High: 2,053 |
France: 21.9%/36.1%/30.5% | ||
| P < 0.0001 | |||
| Lee et al., 2014 (137) (South Korea) | 736 | SCS | — |
| 71 (523/736) | |||
| Lin et al., 2016 (107) (Taiwan) | 24,109 | — | SCS |
| 3 mo: 8.0 (1,926/24,109) | |||
| 12 mo: 22.3 (5,378/24,109) | |||
| Luskin et al., 2016 (49) (U.S.) | 67,860 | Any OCS use | — |
| 66.0 (44,764/67,860) | |||
| Walters et al., 2011 (101) (UK) | 3,320 | — | OCS |
| Cases: 1,660 | Cases: 57.4% | ||
| Control subjects: 1,660† | Control subjects: 42.6%†P < 0.001 | ||
| Windt and Glaeske, 2010 (138) (Germany) | DMP: 317 | OCS | OCS |
| Not DMP (control): 317‡ | DMP: 26.5 (84/317) | DMP: 25.9 (82/317) | |
| Not DMP (all): 20,566 | Control: 24.3 (77/317)§ | Control: 20.5 (65/317)§P = 0.002 | |
| Not DMP: 25.9 (5,320/20,566) | |||
| Wong et al., 2010 (83) (U.S.) | 1,835 | OCS | OCS |
| 48.2 (884/1,835) | 48.1 (882/1,835) | ||
| GINA step 2 or greater treatment | |||
| Ali et al., 2015 (77) (UK) | 51,103 | — | OCS |
| ICS: 46,928 | Overall: 5.8 (2,976/51,103) | ||
| LABA: 714 | By postindex Tx | ||
| ICS/LABA: 3,461 | ICS: 5.7 (2,673/46,928) | ||
| LABA: 6.4 (46/714) | |||
| ICS/LABA: 7.4 (257/3,461) | |||
| Bengtson et al., 2017 (4) (U.S.) | Escalation: 5,044|| Unchanged: 21,967|| |
OCS | — |
| Unchanged|| | |||
| 31.9 (7,002/21,967) | |||
| Escalation|| | |||
| Pre: 29.8 (1,501/5,044) | |||
| Post: 30.7 (1,548/5,044) | |||
| Corrao et al., 2016 (84) (Italy) | 2,335 | OCS | — |
| 18.3 (428/2,335) | |||
| Hagiwara et al., 2010 (139) (U.S.) | FP: 469 | SCS | — |
| FSC: 3,881 | Matched¶: | ||
| FP: 32 (143/447) | |||
| FSC: 24 (106/447) P = 0.006 | |||
| Hagiwara et al., 2013 (140) (U.S.) | 18,283 | SCS | — |
| FSC: 14,044 | Matched**: | ||
| MF: 4,239 | FSC: 18.1 (688/3,799) | ||
| MF: 20.5 (780/3,799) P < 0.001 | |||
| Hagiwara et al., 2014 (141) (U.S.) | 7,779 | — | SCS claims and procedures |
| FP: 2,010 | FP: 69 (1,385/2,010) | ||
| FSC: 5,769 | FSC: 73 (4,232/5,769) P < 0.001 | ||
| Laforest et al., 2014 (85) (France) | 919 | — | OCS |
| Overall: 46.4 (394/849) | |||
| Laforest et al., 2014 (86) (France) | 2,162 | OCS | OCS |
| ICS: | 2008, % (n) | 2007, % (n) | |
| 1,757 | ICS (N = 1,757) | ICS (N = 1,757) | |
| ICS+LTRA: 1,826 | 0 units: 57.4 (1,009) | 0: 52.8 (928) | |
| 1 unit: 22.1 (388) | 1: 24.4 (428) | ||
| 2 units: 10.6 (187) | 2: 11.5 (202) | ||
| ≥3 units: 9.8 (173) | ≥3: 11.3 (199) | ||
| ICS+LTRA (N = 1,826) | ICS+LTRA | ||
| 0 units: 57.7 (1,053) | (N = 1,826) | ||
| 1 unit: 22.1 (403) | 0 units: 53.1 (970) | ||
| 2 units: 10.7 (195) | 1 unit: 24.3 (443) | ||
| ≥3 units: 9.6 (175) | 2 units: 11.4 (209) | ||
| ≥3 units: 11.2 (204) | |||
| Moderate-to-severe or severe asthma | |||
| Broder et al., 2011 (87) (U.S.) | 2003: 302 | OCS | — |
| 2004: 970 | 2007 cohort: 33.2 (459/1,382)†† |
||
| 2005: 1,301 | |||
| 2006: 1,361 | |||
| 2007: 1,382 | |||
| Bruno et al., 2014 (88) (France/Italy) | 102 | OCS | — |
| 64.7 (66/102) | |||
| DiSantostefano and Davis, 2011 (142) (UK) | 1,233 | SCS | SCS |
| 1–6 mo: 11% | 7–12 mo: 9% | ||
| 7–12 mo: 10% | 1–6 mo: 19% | ||
| Eisner et al., 2012 (89) (U.S.) | 2,878 | — | OCS |
| 51.2 (1,473/2,878) | |||
| Lafeuille et al., 2013 (90) (U.S.) | 3,044 | — | OCS |
| 49 (1,479/3,044) | |||
| Lafeuille et al., 2012 (78) (U.S.) | 644 | — | 93.5 (602/644) |
| (OCS) | |||
| Sposato et al., 2017 (143) (Italy) | 340 | OCS | — |
| OMB Tx duration | ≤12 mo: 13% | ||
| ≤12 mo: 39 | 12–≤24 mo: 9% | ||
| 12–≤24 mo: 94 | 24–≤60 mo: 6% | ||
| 24–≤60 mo: 171 | >60 mo: 3%‡‡ | ||
| >60 mo: 36 | ‡‡P = 0.044 vs. ≤12 mo | ||
| Sullivan et al., 2015 (91) (U.S.) | 25,297 | OCS | OCS |
| HDICS: 11,445 | HDICS: 34% | HDICS: 35% | |
| HICS: 6,926 | HICS: 65% | HICS: 53% | |
| OMB: 856 | OMB: 52% | OMB: 63% | |
| Sweeney et al., 2014 (144) (UK) | 2,670 pts with new ICS/LABA Rx and no prior ICS Rx | — | OCS |
| 5 (132/2,670) | |||
| Turner et al., 2017 (145) (UK) | 2,660 | OCS | — |
| FDC ICS/LABA: 6.5% | |||
| ICS+LABA: | |||
| 8.8% P = 0.084 |
Definition of abbreviations: CI = confidence interval; DMP = disease management program; FDC = fixed-dose combination; FP = fluticasone propionate; FSC = FP/SAL fixed-dose combination inhaler; GINA = Global Initiative for Asthma; HDICS = high-dosage ICS; HICS = high-intensity corticosteroids; ICS = inhaled corticosteroids; LABA = long-acting β2-agonists; LTRA = leukotriene receptor antagonists; MF = mometasone furoate; OCS = oral corticosteroids; OMB = omalizumab; Rx = prescription; SABA = short-acting β2-agonists; SCS = systemic corticosteroids; Tx = treatment.
Groups were defined according to the value of the ICS to total asthma medication ratio in 2008: R = 0% (non-ICS users), 0% < R < 50% (low ICS ratio group), and R ≥ 50% (high ICS ratio group). The ratio constituted the proportion of prescribed units of ICS out of the overall number of respiratory medication units prescribed during 2008.
Patients with asthma and a diagnosis of depression during the study period (cases) were matched to patients with asthma without depression (control subjects) according to the date of asthma diagnosis.
Occasional, intermittent, or continuous ICS/LABA use in baseline period.
Patients in the DMP group were propensity matched with non-DMP control subjects based on a range of variables, including demographics, asthma care/therapy, and comorbidities.
Escalation group: ICS or ICS-containing therapy dosage increase; a switch between ICS, LABA, or LTRA, or add-on of another controller within 12 months after the index date. Unchanged group: patients with ≥1 additional fill indicating continuation of index treatment regimen within 12 months after the index date.
Patients receiving FSC who stepped down to FSC at a smaller dosage of FP or switched to FP only at the same dosage. Patients in the FSC group were matched to those in the FP group through propensity score matching.
Each patient in the FSC group was matched to one patient in the MF group through propensity score techniques.
Based on OCS use in the top 10 medication patterns.
Pharmacist intervention to reduce SABA over-dispensing.