ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Relationship of Annual Short-Acting Beta2-Agonist Use and Systemic Corticosteroid Exposure in Children and Adults with Asthma in the United States
Session Title
TP15 - TP015 UPDATES IN ADHERENCE AND TREATMENT OF LUNG DISEASE
Abstract
A1611 - Relationship of Annual Short-Acting Beta2-Agonist Use and Systemic Corticosteroid Exposure in Children and Adults with Asthma in the United States
Author Block: N. L. Lugogo1, I. A. Gilbert2, M. Pollack2, H. Gandhi2, J. P. Tkacz3, M. J. Lanz4; 1University of Michigan, Ann Arbor, MI, United States, 2AstraZeneca, Wilmington, DE, United States, 3IBM Watson Health, Cambridge, MA, United States, 4AAADRS Clinical Research Center, Coral Gables, FL, United States.
Rationale: Systemic corticosteroids (SCS) can be lifesaving for patients experiencing asthma exacerbations; however, 4 annual courses or 500-1000 mg cumulatively over years can lead to acute and chronic illnesses. As short-acting beta2-agonist (SABA) use without concomitant inhaled corticosteroids (ICS) may increase risk of exacerbations necessitating SCS, we analyzed relationships between SABA and SCS exposures. Methods: IBM® MarketScan® research databases of 2010-2017 administrative claims for US patients ≥4 years old receiving SABA were evaluated. Patients were indexed on a random SABA claim and had 12-months’ continuous eligibility pre- and post-index, an asthma diagnosis pre- through 60-days post-index, and either ≥1 post-index SABA or maintenance claim. Three SABA groups were analyzed: Low (index only), Medium (2-3 fills), High (≥4 fills). Patients with data outside clinical plausibility (1st-99.8th percentile of SCS exposure) were excluded. Patients with maintenance fills of <32 days’ supply were classified as SABA-only; post-index medication possession ratio (MPR) was determined on all other maintenance claims. Annual post-index outpatient and mail-order SCS claims and cumulative exposure for patients with and without maintenance and by SABA group were compared (statistics were descriptive and unadjusted, significance p≤0.05). Results: 1,134,143 patients were identified (53.5% female; mean [SD] age 26.0 [20.6]), and 1,085,698 were included; 51.8% filled SABA-only and 48.2% SABA+Maintenance therapy. A greater proportion of SABA-only patients had ≥1 SCS claim vs SABA+Maintenance (49.5% vs 43.7%), while a higher percentage with SABA+Maintenance had ≥2 SCS (20.0% vs 16.0%) and ≥4 SCS fills (4.6% vs 1.9%). Cumulative SCS exposures did not differ in patients filling SCS (SABA: 640 [1,268] mg vs SABA+Maintenance: 934 [1,584] mg; p=0.84); more patients with SABA+Maintenance vs SABA-only had ≥500 mg (21.1% vs 16.8%) or ≥1000 mg (11.7% vs 7.9%) of SCS. The proportions of patients with SCS exposures ≥500 or ≥1000 mg in the SABA-only and SABA+Maintenance groups increased with increasing SABA fills. Among SABA+Maintenance patients, 68.8% had an MPR of <50% and 10.5% had an MPR ≥80%. Lower MPR was associated with a higher proportion of patients with SCS exposures ≥500 mg (22.2% vs 15.4%, p<0.0001) and ≥1000 mg (12.5% vs 7.9%, p<0.0001). Conclusion: Many patients with asthma have SCS exposures potentially leading to acute and chronic illnesses. The proportion of patients with high-risk SCS exposures increased with increasing SABA and decreased with higher anti-inflammatory maintenance MPR. Treatment strategies enhancing SABA use with concomitant ICS could mitigate SCS exposure and associated health risks. Funding: AstraZeneca
Author Block: N. L. Lugogo1, I. A. Gilbert2, M. Pollack2, H. Gandhi2, J. P. Tkacz3, M. J. Lanz4; 1University of Michigan, Ann Arbor, MI, United States, 2AstraZeneca, Wilmington, DE, United States, 3IBM Watson Health, Cambridge, MA, United States, 4AAADRS Clinical Research Center, Coral Gables, FL, United States.
Rationale: Systemic corticosteroids (SCS) can be lifesaving for patients experiencing asthma exacerbations; however, 4 annual courses or 500-1000 mg cumulatively over years can lead to acute and chronic illnesses. As short-acting beta2-agonist (SABA) use without concomitant inhaled corticosteroids (ICS) may increase risk of exacerbations necessitating SCS, we analyzed relationships between SABA and SCS exposures. Methods: IBM® MarketScan® research databases of 2010-2017 administrative claims for US patients ≥4 years old receiving SABA were evaluated. Patients were indexed on a random SABA claim and had 12-months’ continuous eligibility pre- and post-index, an asthma diagnosis pre- through 60-days post-index, and either ≥1 post-index SABA or maintenance claim. Three SABA groups were analyzed: Low (index only), Medium (2-3 fills), High (≥4 fills). Patients with data outside clinical plausibility (1st-99.8th percentile of SCS exposure) were excluded. Patients with maintenance fills of <32 days’ supply were classified as SABA-only; post-index medication possession ratio (MPR) was determined on all other maintenance claims. Annual post-index outpatient and mail-order SCS claims and cumulative exposure for patients with and without maintenance and by SABA group were compared (statistics were descriptive and unadjusted, significance p≤0.05). Results: 1,134,143 patients were identified (53.5% female; mean [SD] age 26.0 [20.6]), and 1,085,698 were included; 51.8% filled SABA-only and 48.2% SABA+Maintenance therapy. A greater proportion of SABA-only patients had ≥1 SCS claim vs SABA+Maintenance (49.5% vs 43.7%), while a higher percentage with SABA+Maintenance had ≥2 SCS (20.0% vs 16.0%) and ≥4 SCS fills (4.6% vs 1.9%). Cumulative SCS exposures did not differ in patients filling SCS (SABA: 640 [1,268] mg vs SABA+Maintenance: 934 [1,584] mg; p=0.84); more patients with SABA+Maintenance vs SABA-only had ≥500 mg (21.1% vs 16.8%) or ≥1000 mg (11.7% vs 7.9%) of SCS. The proportions of patients with SCS exposures ≥500 or ≥1000 mg in the SABA-only and SABA+Maintenance groups increased with increasing SABA fills. Among SABA+Maintenance patients, 68.8% had an MPR of <50% and 10.5% had an MPR ≥80%. Lower MPR was associated with a higher proportion of patients with SCS exposures ≥500 mg (22.2% vs 15.4%, p<0.0001) and ≥1000 mg (12.5% vs 7.9%, p<0.0001). Conclusion: Many patients with asthma have SCS exposures potentially leading to acute and chronic illnesses. The proportion of patients with high-risk SCS exposures increased with increasing SABA and decreased with higher anti-inflammatory maintenance MPR. Treatment strategies enhancing SABA use with concomitant ICS could mitigate SCS exposure and associated health risks. Funding: AstraZeneca
