吸入性糖皮质激素的依从性和美泊利单抗治疗重症哮喘的临床结果
2020/03/11
摘要
背景：吸入性糖皮质激素（ICS）在大多数哮喘患者中可达到疾病控制，尽管哮喘患者对处方ICS的依从性通常较差。严重嗜酸性粒细胞哮喘（SEA）的患者可能需要口服皮质类固醇（OCS）和/或生物制剂如美泊利单抗治疗。目前尚不清楚ICS依从性是否会改变对生物疗法的临床反应。
方法：我们观察美泊利单抗治疗1年的OCS依赖性SEA患者的ICS依从性和临床结局。 计算生物制剂启动前一年和启动后一年的ICS药物占有率（MPR；根据处方/预期数量发布的ICS剂量数）。依从性定义为良好：MPR> 0.75，中度：0.74-0.51，差：<0.5。 我们观察了12个月的生物治疗后的结局，包括OCS降低和年加重率（AER），这是通过使用美泊利单抗的ICS依从性分层的。
结果：在109名开始使用美泊利单抗的患者中，最终完成12个月治疗的91名患者纳入分析。当患者接受美泊利单抗时，68％ICS依从性良好，而16名患者（18％）的ICS依从性差。队列中ICS使用在美泊利单抗使用之前（MPR 0.81±0.32）和使用时（0.82±0.32；p = 0.78）保持相似。 依从性良好的患者较依从性差的患者的OCS剂量（OCS降低百分比中位数100（IQR 74-100）比60（IQR 27-100）；p = 0.031）和加重率（AER变化-2.1±3.1比0.3±2.5；p = 0.011）降低更大。良好的ICS依从性可预测停止OCS维持的可能性（调整OR 3.19；95％CI 1.02-9.94；p = 0.045）。
结论：ICS非依从性在接受美泊利单抗的SEA患者中很常见，并且与OCS需求量降低和AER降低程度较小相关。
Adherence to Inhaled Corticosteroids and Clinical Outcomes in Mepolizumab Therapy for Severe Asthma.
d'Ancona G, Kavanagh J, Roxas C, Green L, Fernandes M, Thomson L, Dhariwal J, Nanzer AM, Jackson DJ, Kent BD.
Abstract
BACKGROUND:Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatics, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma (SEA) may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy.
MEthodS:We examined ICS adherence and clinical outcomes in OCS-dependent SEA patients who completed 1 year of mepolizumab therapy. The ICS Medicines Possession Ratio was calculated (MPR; the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR>0.75, intermediate: 0.74-0.51 and poor: <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab.
RESULTS:Of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. Whilst receiving mepolizumab, 68% had good ICS adherence, with 16(18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and on mepolizumab (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median percentage OCS reduction 100(IQR 74-100) versus 60(IQR 27-100); p=0.031) and exacerbations (AER change -2.1±3.1 versus 0.3±2.5; p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19;95%CI 1.02-9.94; p=0.045).
CONCLUSIONS:ICS non-adherence is common in SEA patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.
背景：吸入性糖皮质激素（ICS）在大多数哮喘患者中可达到疾病控制，尽管哮喘患者对处方ICS的依从性通常较差。严重嗜酸性粒细胞哮喘（SEA）的患者可能需要口服皮质类固醇（OCS）和/或生物制剂如美泊利单抗治疗。目前尚不清楚ICS依从性是否会改变对生物疗法的临床反应。
方法：我们观察美泊利单抗治疗1年的OCS依赖性SEA患者的ICS依从性和临床结局。 计算生物制剂启动前一年和启动后一年的ICS药物占有率（MPR；根据处方/预期数量发布的ICS剂量数）。依从性定义为良好：MPR> 0.75，中度：0.74-0.51，差：<0.5。 我们观察了12个月的生物治疗后的结局，包括OCS降低和年加重率（AER），这是通过使用美泊利单抗的ICS依从性分层的。
结果：在109名开始使用美泊利单抗的患者中，最终完成12个月治疗的91名患者纳入分析。当患者接受美泊利单抗时，68％ICS依从性良好，而16名患者（18％）的ICS依从性差。队列中ICS使用在美泊利单抗使用之前（MPR 0.81±0.32）和使用时（0.82±0.32；p = 0.78）保持相似。 依从性良好的患者较依从性差的患者的OCS剂量（OCS降低百分比中位数100（IQR 74-100）比60（IQR 27-100）；p = 0.031）和加重率（AER变化-2.1±3.1比0.3±2.5；p = 0.011）降低更大。良好的ICS依从性可预测停止OCS维持的可能性（调整OR 3.19；95％CI 1.02-9.94；p = 0.045）。
结论：ICS非依从性在接受美泊利单抗的SEA患者中很常见，并且与OCS需求量降低和AER降低程度较小相关。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Eur Respir J (IF: 11.807) 2020 Feb 20. pii: 1902259. doi: 10.1183/13993003.02259-2019. [Epub ahead of print])
(Eur Respir J (IF: 11.807) 2020 Feb 20. pii: 1902259. doi: 10.1183/13993003.02259-2019. [Epub ahead of print])
Adherence to Inhaled Corticosteroids and Clinical Outcomes in Mepolizumab Therapy for Severe Asthma.
d'Ancona G, Kavanagh J, Roxas C, Green L, Fernandes M, Thomson L, Dhariwal J, Nanzer AM, Jackson DJ, Kent BD.
Abstract
BACKGROUND:Inhaled corticosteroids (ICS) achieve disease control in the majority of asthmatics, although adherence to prescribed ICS is often poor. Patients with severe eosinophilic asthma (SEA) may require treatment with oral corticosteroids (OCS) and/or biologic agents such as mepolizumab. It is unknown if ICS adherence changes on, or alters clinical response to, biologic therapy.
MEthodS:We examined ICS adherence and clinical outcomes in OCS-dependent SEA patients who completed 1 year of mepolizumab therapy. The ICS Medicines Possession Ratio was calculated (MPR; the number of doses of ICS issued on prescription/expected number) for the year before and the year after biologic initiation. Good adherence was defined as MPR>0.75, intermediate: 0.74-0.51 and poor: <0.5. We examined outcomes after 12 months of biologic therapy, including OCS reduction and annualised exacerbation rate (AER), stratified by adherence to ICS on mepolizumab.
RESULTS:Of 109 patients commencing mepolizumab, 91 who had completed 12 months of treatment were included in the final analysis. Whilst receiving mepolizumab, 68% had good ICS adherence, with 16(18%) having poor ICS adherence. ICS use within the cohort remained similar before (MPR 0.81±0.32) and on mepolizumab (0.82±0.32; p=0.78). Patients with good adherence had greater reductions in OCS dose (median percentage OCS reduction 100(IQR 74-100) versus 60(IQR 27-100); p=0.031) and exacerbations (AER change -2.1±3.1 versus 0.3±2.5; p=0.011) than those with poor adherence. Good ICS adherence predicted the likelihood of stopping maintenance OCS (adjusted OR 3.19;95%CI 1.02-9.94; p=0.045).
CONCLUSIONS:ICS non-adherence is common in SEA patients receiving mepolizumab, and is associated with a lesser reduction in OCS requirements and AER.
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