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

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Ayad K AliLeslie Hendeles

Abstract

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

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Citations

Jun 12, 2018·Statistics in Medicine·Dirk EndersIris Pigeot
Jun 18, 2017·The European Respiratory Journal·Mohammad A Al SallakhGwyneth A Davies
Sep 17, 2019·American Journal of Respiratory and Critical Care Medicine·Eugene R BleeckerTrung N Tran
Jun 11, 2019·BMJ Open Respiratory Research·Cristina LongoTracie A Barnett

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