Journal of Asthma and Allergy (Aug 2022)

A Comparison of the Effectiveness of Asthma Medications on Asthma Exacerbations in Real World National Cohort

  • Park HJ,
  • Jeon S,
  • Lee HS,
  • Kim BY,
  • Chae YJ,
  • Kim GO,
  • Park JW,
  • Lee JH

Journal volume & issue
Vol. Volume 15
pp. 1155 – 1165

Abstract

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Hye Jung Park,1 Soyoung Jeon,2 Hye Sun Lee,2 Bo Yeon Kim,3 Yu Jin Chae,3 Gui Ok Kim,3 Jung-Won Park,4,5 Jae-Hyun Lee4,5 1Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea; 3Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea; 4Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; 5Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Jae-Hyun Lee, Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, Tel +82-2-2228-1977, Fax +82-2-393-6884, Email [email protected]: Although a wide variety of asthma medications have been developed and are used in clinical practice, there is limited evidence of their comparative effects on asthma exacerbations.Methods: We used claims data provided by the Health Insurance Review and Assessment Service. We selected subjects commencing asthma treatment between July 1, 2017 and June 30, 2018, with no change in drug regimen. The primary outcome was asthma exacerbation requiring systemic corticosteroids. Cox regression analysis was used to assess outcomes considering the exacerbation-free period.Results: Of the 254,951 asthma subjects, 107,694 subjects (42.2%) experienced asthma exacerbation. Inhaled corticosteroids (ICSs) (hazard ratio [HR], 0.378– 0.508), ICS-long-acting β2-agonist (LABAs) (HR, 0.284– 0.479), long-acting muscarine antagonists (LAMAs) (HR, 0.432– 0.572), leukotriene receptor antagonists (LTRAs) (HR, 0.371– 0.419), and xanthines (HR, 0.326– 0.482) significantly reduced the rate of first and second exacerbation of asthma (all P-values, < 0.001). The clinical effectiveness of asthma medications varied according to the active ingredient (HR 0.164– 0.670) and was significant for all active ingredients (all P-values, < 0.001). The effectiveness of combination treatment using ICS-LABA and LTRA varied (HR, 0.159– 0.670); however, all combination treatment options evaluated were effective in preventing asthma exacerbations (all P-values, < 0.001). Long-term use of ICS-LABA (HR, 0.278– 0.653), LTRA (HR, 0.259– 0.628), and xanthines (HR, 0.351– 0.783) showed consistent effectiveness (all P-values, < 0.001).Conclusion: This real-world study showed that the effectiveness of asthma medications varied according to drug type, active ingredient, combination, and period of use, although effectiveness was significant in all cases studied.Keywords: asthma, medication, exacerbation, real-world data, drug, combination

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