Assessment of Adherence and Asthma Medication Ratio for a Once-Daily and Twice-Daily Inhaled Corticosteroid/Long-Acting β-Agonist for Asthma

Stanford, Richard H.; Averell, Carlyne M; Parker, Emily D.; Blauer‐Peterson, Cori; Reinsch, Tyler; Buikema, Ami

doi:10.1016/j.jaip.2018.12.021

Cited by 27 publications

(44 citation statements)

References 22 publications

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“…Our results are broadly comparable with those of three database studies performed in the USA and Japan [ 21 , 35 , 36 ]. In their retrospective cohort study, Stanford et al .…”

Section: Discussionsupporting

confidence: 90%

“…In their retrospective cohort study, Stanford et al . found that patients initiating once-daily FF/VI were more likely to be adherent (measured by PDC) and less likely to discontinue treatment than patients initiating twice-daily BUD/FM; however, persistence was low for both treatments [ 35 ]. Averell et al similarly found that adherence (measured by PDC) was higher and discontinuation less likely for FF/VI compared with BUD/FM and fluticasone propionate/salmeterol (FP/SAL) [ 9 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, two binary outcomes-patients C 50% adherent and patients C 80% adherent-were created and analysed. Taking C 80% of medication as prescribed has been generally considered as acceptable adherence for clinical outcomes, based on findings from a seminal hypertension study [19]; however, as it is now recognised that this cut-off value may vary for different diseases and classes of medication [20], we also analysed a lower adherence cut-point, chosen to allow comparison with previous asthma studies [21][22][23][24][25]. The protocol was approved by local ethics committees.…”

Section: Methodsmentioning

confidence: 99%

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Persistence and Adherence to ICS/LABA Drugs in UK Patients with Asthma: A Retrospective New-User Cohort Study

et al. 2020

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Introduction: Asthma is associated with significant economic burden. Inhaled corticosteroid and long-acting beta 2-agonist (ICS/LABA) combination therapies are considered mainstays of treatment. We describe real-world use of ICS/LABAs by comparing treatment persistence and adherence among patients with asthma in the United Kingdom initiating fluticasone furoate/vilanterol (FF/VI) versus budesonide/ formoterol (BUD/FM) or beclometasone dipropionate/formoterol (BDP/FM). Methods: A retrospective new-user active comparator database study was conducted in the IQVIA Medical Research Database. Propensity score (PS) matching was performed for FF/VI versus BUD/FM, and FF/VI versus BDP/ FM. The primary objective was to compare patient treatment persistence (time to discontinuation), while secondary objectives included assessing adherence (mean proportion of days covered [PDC] with medication in the study period) and the proportions of patients achieving C 50% and C 80% PDC.

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“…Our results are broadly comparable with those of three database studies performed in the USA and Japan [ 21 , 35 , 36 ]. In their retrospective cohort study, Stanford et al .…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Persistence and Adherence to ICS/LABA Drugs in UK Patients with Asthma: A Retrospective New-User Cohort Study

et al. 2020

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“…Adherence rates in patients with asthma are known to be low, both in paediatric and adult studies 4 5. Suboptimal adherence to inhaled medication is associated with poor health outcomes, including lack of symptom control, exacerbations, emergency department visits and hospitalisations, leading to disease progression, additional social burden and health costs 6.…”

Section: Introductionmentioning

confidence: 99%

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

et al. 2019

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ObjectiveWe aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.DesignBaseline data from two prospective multicentre observational studies.Setting29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal.Participants395 patients (≥13 years old) with persistent asthma.MeasuresData on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0–50; medium 51–80; high 81–100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients’ and physicians’ VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation.ResultsHigh inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65–95) mm; 53% VAS>80) and by physicians (84 (68–95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%).ConclusionAlthough both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.

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“…As planned, no statistical testing has been conducted on these data. Further assessment of adherence to FF/VI through electronic monitoring devices will aid better understanding of this driver of effectiveness [34–37].…”

Section: Potential Drivers Of Effectiveness In Asthma and Copdmentioning

confidence: 99%

Can medicines development improve outcomes in asthma and chronic obstructive pulmonary disease management by driving effectiveness?

et al. 2019

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Despite the availability of treatment guidelines and inhaled medications for asthma and chronic obstructive pulmonary disease (COPD), much remains to be done to lessen the burden of these respiratory diseases for patients. The challenge of selecting effective and efficacious drugs for patients is a key focus area for healthcare professionals. Here we discuss the concept of “drivers of effectiveness”— features of a medicine which may increase or decrease its effectiveness in the presence of real-world factors — and highlight the importance of considering these drivers in the early stages of drug development, and exploring their impact in carefully designed pragmatic trials. Using the Salford Lung Studies (SLS) in asthma and COPD as an illustrative example, we discuss various features of the inhaled corticosteroid/long-acting β 2 -agonist combination, fluticasone furoate/vilanterol (FF/VI), as potential drivers of effectiveness that may have contributed to the improved patient outcomes observed with initiation of FF/VI versus continuation of usual care in the UK primary care setting.

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Assessment of Adherence and Asthma Medication Ratio for a Once-Daily and Twice-Daily Inhaled Corticosteroid/Long-Acting β-Agonist for Asthma

Cited by 27 publications

References 22 publications

Persistence and Adherence to ICS/LABA Drugs in UK Patients with Asthma: A Retrospective New-User Cohort Study

Persistence and Adherence to ICS/LABA Drugs in UK Patients with Asthma: A Retrospective New-User Cohort Study

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

Can medicines development improve outcomes in asthma and chronic obstructive pulmonary disease management by driving effectiveness?

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