Understanding the Clinical Implications of Individual Patient Characteristics and Treatment Choice on the Risk of Exacerbation in Asthma Patients with Moderate–Severe Symptoms

Journal article

INTRODUCTION: The assessment of future risk has become an important feature in the management of patients with asthma. However, the contribution of patient-specific characteristics and treatment choices to the risk of exacerbation is poorly understood. Here we evaluated the effect of interindividual baseline differences on the risk of exacerbation and treatment performance in patients receiving regular maintenance doses of inhaled corticosteroids (ICS) or ICS/long-acting beta-agonists (LABA) combination therapy. METHODS: Exacerbations and changes to asthma symptoms 5-item Asthma Control Questionnaire (ACQ-5) were simulated over a 12-month period using a time-to-event and a longitudinal model developed from phase III/IV studies in patients with moderate-severe asthma (N = 16,282). Simulations were implemented to explore treatment performance across different scenarios, including randomised designs and real-world settings. Treatment options included regular dosing with ICS monotherapy [fluticasone propionate (FP)] and combination therapy [fluticasone propionate/salmeterol (FP/SAL) or budesonide/formoterol (BUD/FOR)]. Exacerbation rate was analysed using the log-rank test. The cumulative incidence of events was summarised stratified by treatment. RESULTS: ) (p < 0.01) and in patients who do not achieve symptom control on FP monotherapy. CONCLUSIONS: Individual baseline characteristics and treatment choices affect future risk. Achieving comparable levels of symptom control whilst on treatment does not imply comparable risk reduction, as shown by the lower exacerbation rates in FP/SAL vs. BUD/FOR-treated patients. These factors should be considered as a basis for personalised clinical management of patients with moderate-severe asthma.

Authors: Singh, D; Oosterholt, S; Pavord, I; Garcia, G; Abhijith PG,

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Advances in Therapy
• Volume: 40
• Issue: 10
• Pages: 4606-4625
• Publication date: 2023-08-17
• DOI: 10.1007/s12325-023-02590-2
• EISSN: 1865-8652
• ISSN: 0741-238X
• Language: English
• Keywords: Budesonide/formoterol; Fluticasone propionate; Exacerbation; Dosing; Salmeterol; Budesonide; Asthma; Fluticasone; Body mass index; Medicine; Formoterol; Internal medicine; Incidence (geometry)