Application of Multicategory Exposure Marginal Structural Models to Investigate the Association between Long-Acting Beta-Agonists and Prescribing of Oral Corticosteroids for Asthma Exacerbations in the Clinical Practice Research Datalink

Mar 1, 2015, 00:00
10.1016/j.jval.2014.11.007
https://www.valueinhealthjournal.com/article/S1098-3015(14)04763-9/fulltext
Title : Application of Multicategory Exposure Marginal Structural Models to Investigate the Association between Long-Acting Beta-Agonists and Prescribing of Oral Corticosteroids for Asthma Exacerbations in the Clinical Practice Research Datalink
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(14)04763-9&doi=10.1016/j.jval.2014.11.007
First page : 260
Section Title : Comparative Effectiveness Research/Health Technology Assessment (HTA)
Open access? : No
Section Order : 13

Objective

To examine the comparative effectiveness of inhaled long-acting beta-agonist (LABA), inhaled corticosteroid (ICS), and ICS/LABA combinations.

Methods

We used a retrospective cohort design of patients older than 12 years with asthma diagnosis in the Clinical Practice Research Datalink to evaluate asthma-related morbidity measured by oral corticosteroid (OCS) initiation within 12 months of initiating LABAs, ICSs, or ICSs/LABAs. Asthma severity 12 months before drug initiation (use of OCSs, asthma-related hospital or emergency department visits, and number of short-acting beta-agonist prescriptions) and during follow-up (short-acting beta-agonist prescriptions and total number of asthma drug classes) was adjusted as a time-varying variable via marginal structural models.

Results

A total of 51,103 patients with asthma were followed for 12 months after receiving first prescription for study drugs from 1993 to 2010. About 92% initiated ICSs, 1% initiated LABAs, and 7% initiated ICSs/LABAs. Compared with ICSs, LABAs were associated with a 10% increased risk of asthma exacerbations requiring short courses of OCSs (hazard ratio [HR] 1.10; 95% confidence interval [CI] 1.07–1.18). ICS/LABA initiators were 62% less likely than ICS initiators (HR 0.38; 95% CI 0.12–0.66) and 50% less likely than LABA initiators to receive OCS prescriptions for asthma exacerbations (HR 0.50; 95% CI 0.14–0.78).

Conclusions

In concordance with current asthma management guidelines, inhaled LABAs should not be prescribed as monotherapy to patients with asthma. The findings suggest the presence of time-dependent confounding by asthma severity, which was accounted for by the marginal structural model.

Categories :
  • Clinical Outcomes
  • Comparative Effectiveness or Efficacy
  • Respiratory-Related Disorders
  • Specific Diseases & Conditions
Tags :
  • asthma
  • Clinical Practice Research Datalink
  • long-acting beta-agonists
  • marginal structural models
Regions :
  • Africa
  • Eastern and Central Europe
  • Middle East
  • Western Europe
ViH Article Tags :