Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2025
Comparative effectiveness of fixed-dose inhaled corticosteroid/long-acting beta-agonist therapy in adult patients with asthma.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Kung Te-Jung, Weng Ching-Fu, Wu Shan-Chieh, Lin Fang-Ju
Аннотация
BACKGROUND: Inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA) therapy is a mainstay of asthma management, yet real-world comparative evidence across different formulations remains limited.
OBJECTIVE: To compare the effectiveness of prescribed fixed-dose ICS/LABA combinations in reducing moderate-to-severe asthma exacerbations (MSAEs) among adults, stratified by initial ICS dose.
METHODS: This retrospective cohort study used data from Taiwan's National Health Insurance Research Database and Cause of Death Registry (2016-2021). Adults with asthma who initiated fixed-dose ICS/LABA therapy between 2017 and 2020 were included. Treatment groups comprised budesonide/formoterol (reference), extrafine beclometasone dipropionate/formoterol, fluticasone propionate/salmeterol, and fluticasone furoate/vilanterol. Patients were stratified by initial ICS dosage into low-dose and medium-to-high-dose cohorts. Risk of MSAE was assessed using Cox proportional hazards model with inverse probability of treatment weighting for covariate adjustment.
RESULTS: Among 128,426 eligible patients, 35,532 were in the low-dose and 88,954 in the medium-to-high-dose cohort. In the low-dose cohort, extrafine beclometasone dipropionate/formoterol (hazard ratio [HR]: 0.97, 95% CI: 0.88-1.09) and fluticasone propionate/salmeterol (HR: 1.16, 95% CI: 0.98-1.37) had a similar risk of MSAE compared with budesonide/formoterol. In the medium-to-high-dose cohort, fluticasone furoate/vilanterol was associated with a slightly lower MSAE risk compared with budesonide/formoterol (HR: 0.92, 95% CI: 0.86-0.97), particularly in those with prior exacerbations (HR: 0.84, 95% CI: 0.77-0.91). Extrafine beclometasone dipropionate/formoterol (HR: 0.96, 95% CI: 0.89-1.04) and fluticasone propionate/salmeterol (HR: 1.06, 95% CI: 0.98-1.15) had no significant difference.
CONCLUSION: The findings suggest that fluticasone furoate/vilanterol may offer a potential advantage for asthma management compared with other fixed-dose ICS/LABA combinations.
OBJECTIVE: To compare the effectiveness of prescribed fixed-dose ICS/LABA combinations in reducing moderate-to-severe asthma exacerbations (MSAEs) among adults, stratified by initial ICS dose.
METHODS: This retrospective cohort study used data from Taiwan's National Health Insurance Research Database and Cause of Death Registry (2016-2021). Adults with asthma who initiated fixed-dose ICS/LABA therapy between 2017 and 2020 were included. Treatment groups comprised budesonide/formoterol (reference), extrafine beclometasone dipropionate/formoterol, fluticasone propionate/salmeterol, and fluticasone furoate/vilanterol. Patients were stratified by initial ICS dosage into low-dose and medium-to-high-dose cohorts. Risk of MSAE was assessed using Cox proportional hazards model with inverse probability of treatment weighting for covariate adjustment.
RESULTS: Among 128,426 eligible patients, 35,532 were in the low-dose and 88,954 in the medium-to-high-dose cohort. In the low-dose cohort, extrafine beclometasone dipropionate/formoterol (hazard ratio [HR]: 0.97, 95% CI: 0.88-1.09) and fluticasone propionate/salmeterol (HR: 1.16, 95% CI: 0.98-1.37) had a similar risk of MSAE compared with budesonide/formoterol. In the medium-to-high-dose cohort, fluticasone furoate/vilanterol was associated with a slightly lower MSAE risk compared with budesonide/formoterol (HR: 0.92, 95% CI: 0.86-0.97), particularly in those with prior exacerbations (HR: 0.84, 95% CI: 0.77-0.91). Extrafine beclometasone dipropionate/formoterol (HR: 0.96, 95% CI: 0.89-1.04) and fluticasone propionate/salmeterol (HR: 1.06, 95% CI: 0.98-1.15) had no significant difference.
CONCLUSION: The findings suggest that fluticasone furoate/vilanterol may offer a potential advantage for asthma management compared with other fixed-dose ICS/LABA combinations.