Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol

Introduction: It is important that treatment recommendations reflect real-world data when available, as randomised controlled trials have stringent eligibility criteria and do not represent the entire asthma population or their usual ecosystem of care. Limited real-world evidence has compared the ef...

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Autores: Woodcock, Ashley, Blakey, John, Bourdin, Arnaud|||0000-0002-4645-5209, Canonica, G. Walter|||0000-0001-8467-2557, Domingo, Christian|||0000-0001-8358-773X, Ford, Alexander, Hulme, Rosie, Tritton, Theo, Palomares, Ines, Sadhu, Sanchayita, Biswas, Arunangshu, Verma, Manish|||0000-0002-8877-235X
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:326309
Acceso en línea:https://ddd.uab.cat/record/326309
https://dx.doi.org/urn:doi:10.1007/s41030-025-00313-2
Access Level:acceso abierto
Palabra clave:Asthma
Budesonide/formoterol
Comparative effectiveness
England
Fluticasone furoate/vilanterol
General practice
Real-world data
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spelling Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/FormoterolA United Kingdom General Practice Cohort StudyWoodcock, AshleyBlakey, JohnBourdin, Arnaud|||0000-0002-4645-5209Canonica, G. Walter|||0000-0001-8467-2557Domingo, Christian|||0000-0001-8358-773XFord, AlexanderHulme, RosieTritton, TheoPalomares, InesSadhu, SanchayitaBiswas, ArunangshuVerma, Manish|||0000-0002-8877-235XAsthmaBudesonide/formoterolComparative effectivenessEnglandFluticasone furoate/vilanterolGeneral practiceReal-world dataIntroduction: It is important that treatment recommendations reflect real-world data when available, as randomised controlled trials have stringent eligibility criteria and do not represent the entire asthma population or their usual ecosystem of care. Limited real-world evidence has compared the effectiveness of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/FOR) to date in asthma; we explored this in England using patients from general practice. Methodology: We retrospectively compared new FF/VI users and new BUD/FOR users from 1 December 2015 to 28 February 2019, based on de-identified data from the Clinical Practice Research Datalink. The baseline period pre-index was ≥ 1 year; the follow-up period was 1 year. At index, eligible adults (≥ 18 years) with diagnosed asthma had ≥ 1 prescription for FF/VI or BUD/FOR, ≥ 1 years' general practitioner registration and records eligible for linkage to Hospital Episode Statistics. Chronic obstructive pulmonary disease was an exclusion criterion. The primary study outcome assessed the overall asthma exacerbation rate in new FF/VI or BUD/FOR users. Secondary outcomes included oral corticosteroid (OCS) use and medication persistence (analysed using Kaplan-Meier curves). For each treatment comparison, propensity scores were generated and confounding between baseline group characteristics was adjusted via inverse probability of treatment weighting, separately carried out for each study outcome. Intercurrent events (ICEs) were considered for analyses, such as death, loss to follow-up, rescue-medication use, treatment discontinuation or switching. Results: Between groups, baseline attributes were well balanced. Annual per-person rates of exacerbation were numerically similar in the while on-treatment population (measuring outcome until ICE; FF/VI, 0.1356; BUD/FOR, 0.1583 [P = 0.3023]). Patients who continued initiation treatment for 1 year without interruption had significantly lower annual per-person exacerbation rates with FF/VI (0.0722 [n = 425]) versus BUD/FOR (0.2258 [n = 546]) (rate ratio 0.3197 [P = 0.0003]). Patients indexed on FF/VI had significantly fewer OCS prescriptions and lower OCS dosage versus BUD/FOR (respective coefficients: - 0.29 [P = 0.0352]; 0.41 [P = 0.0004]) and improved treatment persistence (hazard ratio: 0.62 [P < 0.0001]). Conclusions: Patients who continued initiation treatment for a year without interruption had reduced exacerbation rates with FF/VI versus BUD/FOR. The FF/VI group also had reduced treatment discontinuation and OCS use. 22025-01-0120252025-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/326309https://dx.doi.org/urn:doi:10.1007/s41030-025-00313-2reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets.https://rightsstatements.org/vocab/InC/1.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3263092026-06-06T12:50:31Z
dc.title.none.fl_str_mv Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
A United Kingdom General Practice Cohort Study
title Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
spellingShingle Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
Woodcock, Ashley
Asthma
Budesonide/formoterol
Comparative effectiveness
England
Fluticasone furoate/vilanterol
General practice
Real-world data
title_short Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
title_full Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
title_fullStr Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
title_full_unstemmed Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
title_sort Real-world Comparative Effectiveness in Patients with Asthma Newly Initiating Fluticasone Furoate/Vilanterol or Budesonide/Formoterol
dc.creator.none.fl_str_mv Woodcock, Ashley
Blakey, John
Bourdin, Arnaud|||0000-0002-4645-5209
Canonica, G. Walter|||0000-0001-8467-2557
Domingo, Christian|||0000-0001-8358-773X
Ford, Alexander
Hulme, Rosie
Tritton, Theo
Palomares, Ines
Sadhu, Sanchayita
Biswas, Arunangshu
Verma, Manish|||0000-0002-8877-235X
author Woodcock, Ashley
author_facet Woodcock, Ashley
Blakey, John
Bourdin, Arnaud|||0000-0002-4645-5209
Canonica, G. Walter|||0000-0001-8467-2557
Domingo, Christian|||0000-0001-8358-773X
Ford, Alexander
Hulme, Rosie
Tritton, Theo
Palomares, Ines
Sadhu, Sanchayita
Biswas, Arunangshu
Verma, Manish|||0000-0002-8877-235X
author_role author
author2 Blakey, John
Bourdin, Arnaud|||0000-0002-4645-5209
Canonica, G. Walter|||0000-0001-8467-2557
Domingo, Christian|||0000-0001-8358-773X
Ford, Alexander
Hulme, Rosie
Tritton, Theo
Palomares, Ines
Sadhu, Sanchayita
Biswas, Arunangshu
Verma, Manish|||0000-0002-8877-235X
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Asthma
Budesonide/formoterol
Comparative effectiveness
England
Fluticasone furoate/vilanterol
General practice
Real-world data
topic Asthma
Budesonide/formoterol
Comparative effectiveness
England
Fluticasone furoate/vilanterol
General practice
Real-world data
description Introduction: It is important that treatment recommendations reflect real-world data when available, as randomised controlled trials have stringent eligibility criteria and do not represent the entire asthma population or their usual ecosystem of care. Limited real-world evidence has compared the effectiveness of fluticasone furoate/vilanterol (FF/VI) and budesonide/formoterol (BUD/FOR) to date in asthma; we explored this in England using patients from general practice. Methodology: We retrospectively compared new FF/VI users and new BUD/FOR users from 1 December 2015 to 28 February 2019, based on de-identified data from the Clinical Practice Research Datalink. The baseline period pre-index was ≥ 1 year; the follow-up period was 1 year. At index, eligible adults (≥ 18 years) with diagnosed asthma had ≥ 1 prescription for FF/VI or BUD/FOR, ≥ 1 years' general practitioner registration and records eligible for linkage to Hospital Episode Statistics. Chronic obstructive pulmonary disease was an exclusion criterion. The primary study outcome assessed the overall asthma exacerbation rate in new FF/VI or BUD/FOR users. Secondary outcomes included oral corticosteroid (OCS) use and medication persistence (analysed using Kaplan-Meier curves). For each treatment comparison, propensity scores were generated and confounding between baseline group characteristics was adjusted via inverse probability of treatment weighting, separately carried out for each study outcome. Intercurrent events (ICEs) were considered for analyses, such as death, loss to follow-up, rescue-medication use, treatment discontinuation or switching. Results: Between groups, baseline attributes were well balanced. Annual per-person rates of exacerbation were numerically similar in the while on-treatment population (measuring outcome until ICE; FF/VI, 0.1356; BUD/FOR, 0.1583 [P = 0.3023]). Patients who continued initiation treatment for 1 year without interruption had significantly lower annual per-person exacerbation rates with FF/VI (0.0722 [n = 425]) versus BUD/FOR (0.2258 [n = 546]) (rate ratio 0.3197 [P = 0.0003]). Patients indexed on FF/VI had significantly fewer OCS prescriptions and lower OCS dosage versus BUD/FOR (respective coefficients: - 0.29 [P = 0.0352]; 0.41 [P = 0.0004]) and improved treatment persistence (hazard ratio: 0.62 [P < 0.0001]). Conclusions: Patients who continued initiation treatment for a year without interruption had reduced exacerbation rates with FF/VI versus BUD/FOR. The FF/VI group also had reduced treatment discontinuation and OCS use.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
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dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/326309
https://dx.doi.org/urn:doi:10.1007/s41030-025-00313-2
url https://ddd.uab.cat/record/326309
https://dx.doi.org/urn:doi:10.1007/s41030-025-00313-2
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
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https://rightsstatements.org/vocab/InC/1.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
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dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
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