LAMA Addition to LABA/ICS Improved Asthma Outcomes, Cost Savings in a Large Patient Study

Adding long-acting muscarinic antagonists (LAMAs) to long-acting β₂ agonists/inhaled corticosteroids (LABA/ICS) as a triple therapy (TT) significantly improved asthma exacerbations, lung function, and reduced health care costs, especially in patients requiring systemic corticosteroids to treat severe exacerbations.

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This observational, retrospective before-and-after study is published in Pharmaceuticals.

“To our knowledge, this is the first study to analyze the effectiveness of LAMA as an add-on therapy to ICS/LABA in Spain,” wrote the researchers of the study. “This suggests that the next steps should be the use of specific tests to measure whether the observed improvements in asthmatic patients’ clinical outcomes are accompanied by an ameliorated HRQoL [health-related quality of life] in asthmatic patients.”

Previous studies suggest that treatment with LAMA in combination with LABA/ICS may improve asthma compared with dual therapy (DT) LABA/ICS. However, these findings had not been confirmed in a clinical setting. In the current study, researchers aimed to analyze the clinical outcomes, use of health care resources, and costs associated with the addition of LAMA to the LABA/ICS therapy in a wide cohort of patients with asthma.

A total of 46,663 patients 18 years and older with asthma between 2017 and 2018 were identified for the analysis from a database of clinical practices in Spain. Of these patients, 5072 (10.8%) were treated with the TT. However, 332 patients were excluded for reasons such as incoherent data, inactivity in the database, or incomplete data. After exclusion, 4740 patients were recruited for the analysis.

Demographic factors such as age, gender, and comorbidities were collected, as well as treatments prescribed from drug-dispensing records. Treatment persistence and duration was estimated from either the index date up to 12 months, up to the switch to another treatment, or at the interruption/discontinuation of medication. Treatment persistence was evaluated at 6 months and 12 months after the index date.

During the follow-up period, health care resource use and costs such as medical visits, hospitalizations, and diagnostic/therapeutic tests were estimated.

This cohort of patients had a mean (SD) age of 64.1 (16.3) years, and 63.8% were women. The mean (SD) time from asthma diagnosis was 32.4 (15.8) years. Additionally, these patients had a mean (SD) of 2.9 (2.0) medical conditions, with the most frequent being arterial hypertension (52.3%), dyslipidemia (41.9%), and obesity (24.0%).

Furthermore, TT reduced the incidence of exacerbations by 16.7% (P < .044) and the number of patients with exacerbations by 8.5% (P < .001) compared with previous DT. TT also significantly improved forced expiratory volume per 1 second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC, which resulted in approximately $624 in savings per patient for society. The rate of patients with severe exacerbations requiring systemic corticosteroids (22.5%) and their hospitalization rates (29.5%) significantly decreased as well, and younger patients (18-44 years) and patients with severe exacerbations (FEV₁ < 60%) performed better upon TT initiation.

However, the researchers acknowledged some limitations to the study. For instance, the study lacked a control group which would have allowed the researchers to directly compare results at the time of obtaining data. Additionally, the time difference and the individual characteristics of each patient included in the analysis may have influenced their development. Other limitations included the inaccuracy of the disease coding system and the lack of variables that could have influenced the results, such as socioeconomic status.

Despite these limitations, the researchers identified significant improvement outcomes with the use of TT compared with DT among a wide cohort of patients with asthma, especially among those with severe exacerbations.

“In conclusion, our results showed that the addition of LAMA to the ICS/LABA therapy improved the clinical outcomes of patients with asthma, including lung function and severe exacerbation rates, particularly in younger patients and those with more severe asthma,” wrote the researchers. “These improvements led to a decrease in the use of concomitant medications and other health care resources, along with cost savings for the Spanish National Health System and society.”

Reference

Plaza V, Domínguez-Ortega J, González-Segura Alsina D, Lo Re D, Sicras-Mainar A. Comprehensive observational study in a large cohort of asthma patients after adding LAMA to ICS/LABA. Pharmaceuticals (Basel). 2023;16(11):1609. doi:10.3390/ph16111609