Patients With Uncontrolled Asthma May Need to Be Considered for Triple Therapy, Posters Find

Globally, asthma control is suboptimal even in patients receiving high-intensity treatments and maintenance oral corticosteroids. Two posters presented at CHEST 2022 reviewed asthma control in patients taking dual and triple therapies.

The annual meeting of the American College of Chest Physicians is being held October 16-19, 2022, in Nashville, Tennessee.

Patients with uncontrolled asthma may experience better outcomes if they are switched to a triple therapy, according to the results of one poster.¹ Researchers presented data on a real-world, retrospective, pre-post study using nationwide claims from the IQVIA PharMetrics Plus database. They assessed asthma control in patients using fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) by comparing asthma control prior to and following the initiation of the triple therapy.

Asthma control was measured by the reduction in the use of oral corticosteroids (OCS) and short-acting β₂ agonists (SABA), as well as the reduction in asthma-related exacerbations. Rescue medications are recommended in asthma treatment guidelines to provide rapid symptomatic relief. However, “excessive use of rescue medications” like SABA and OCS “are key indicators of poor control,” the authors wrote.

The 12 months prior to first dispensing of FF/UMEC/VI (index date) were assessed as the pretreatment period. The 12 months after the index date were the posttreatment period.

The research included 890 patients with asthma. The mean age was 52.0 years, and the majority (56.9%) were female. More than one-third (36.9%) of patients had at least 1 asthma-related exacerbation in the 12 months prior to index date.

The mean number of OCS dispensings per person per year was significantly lower in the posttreatment period compared with the pretreatment period (1.6 vs 2.3; P < .001).

In addition, the following were also significantly (P < .001) lower in the posttreatment period:

• Proportion of patients with at least 1 OCS dispensing
• Mean number of OCS bursts
• Proportion of patients with low OCS exposure

In the posttreatment period, rates of asthma-related exacerbations per person-year (PPY) decreased significantly (0.50 vs 0.84; P < .001). The rate of SABA canister use was also significantly lower (2.61 vs 3.27 canisters; P < .001).

Overall, the study found that initiating treatment with FF/UMEC/VI lowered the use of OCS and SABA and reduced asthma-related exacerbations, which may mean patients had improved asthma control.

“Physicians should consider treatment switch to triple therapy in uncontrolled asthma patients,” the researchers concluded.

A second poster reviewed asthma control in a cohort of UK patients and found nearly half of patients taking inhaled corticosteroids (ICS) and long-acting β agonists (LABA) who were considered adherent to their medication still had somewhat controlled or poorly controlled asthma.²

The Salford Lung Study was a pragmatic, randomized, controlled effectiveness trial. The results presented in the poster were a retrospective cohort study of patients who had previously completed the Salford Lung Study. Asthma control was measured using the Asthma Control Test (ACT), which was completed by patients at the time of consent to the additional follow-up. Results of the ACT were grouped as poor control (< 16), somewhat controlled (16-19), and controlled (> 19).

Adherence to ICS-LABA for the 6 months prior to consent was measured using proportion of days covered (PDC). Adherence was considered a PDC of at least 80%.

A total of 775 patients, with a mean age of 57.6 years, were included. Approximately one-third (34.8%) were male. Based on the results of the ACT, 18.7% of the patients reported had poor control, 20.0% reported being somewhat controlled, and 61.3% reported having controlled asthma.

In the patients receiving ICS-LABA who were considered adherent, 28.6% reported poor control, 20.4% reported being somewhat controlled, and 51% reported having controlled asthma. A smaller proportion of patients on ICS-LABA who were considered nonadherent reported poor control (15.7%) and being somewhat controlled (19.6%). A larger proportion of patients nonadherent to ICS-LABA reported having controlled asthma (64.7%).

The researchers noted that the findings highlight an unmet need for patients with asthma on ICS-LABA, as well as the need to review prescribed therapy and potential additional therapies.

“Given the high burden of need in the patients identified as being adherent, the use of objective measures of control, like ACT and [Asthma Control Questionnaire], is a valuable tool to assess control and identify sub-optimally controlled patients in clinical practice,” they concluded.

Reference

1. Bogart M, Germain G, Laliberté F, Mahendran M, Duh MS. Real-world impact of triple therapy with fluticasone furoate, umeclidinium, and vilanterol on asthma control among US patients with asthma. Presented at: CHEST 2022; Nashville, TN; October 16-19, 2022. Poster 2068.

2. Goodall EC, Wood R, Numbere B, et al. Describing asthma control and adherence in patients with Extended Salford Lung Study (Ex-SLS) prescribing inhaled corticosteroids/long-acting beta agonists (ICS/LABA). Presented at: CHEST 2022; Nashville, TN; October 16-19, 2022. Poster 2067.