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    Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

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    Author
    Postma, DS; Dekhuijzen, R; van der Molen, T; Martin, RJ; van Aalderen, W; Roche, N; Guilbert, TW; Israel, E; van Eickels, D; Khalid, JM; ...
    Date
    2017-03-01
    Source Title
    Allergy, asthma & immunology research
    Publisher
    KOREAN ACAD ASTHMA ALLERGY & CLINICAL IMMUNOLOGY
    University of Melbourne Author/s
    Hutton, Cathy
    Affiliation
    General Practice
    Metadata
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    Document Type
    Journal Article
    Citations
    Postma, D. S., Dekhuijzen, R., van der Molen, T., Martin, R. J., van Aalderen, W., Roche, N., Guilbert, T. W., Israel, E., van Eickels, D., Khalid, J. M., Herings, R. M. C., Overbeek, J. A., Miglio, C., Thomas, V., Hutton, C., Hillyer, E. V. & Price, D. B. (2017). Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids. ALLERGY ASTHMA & IMMUNOLOGY RESEARCH, 9 (2), pp.116-125. https://doi.org/10.4168/aair.2017.9.2.116.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257228
    DOI
    10.4168/aair.2017.9.2.116
    Abstract
    PURPOSE: Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). METHODS: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. RESULTS: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) μg/day and 500 (250-500) μg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. CONCLUSIONS: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.

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