Background: Most randomised clinical trials typically exclude a significant proportion of asthma patients, including\nthose at higher risk of adverse events, with comorbidities, obesity, poor inhaler technique and adherence, or\nsmokers. However, these patients might differentially benefit from extrafine-particle inhaled corticosteroids (ICS).\nThis matched cohort, database study, compared the effectiveness of extrafine-particle with fine-particle ICS in a reallife\npopulation initiating ICS therapy in the Netherlands.\nMethods: Data were from the Pharmo Database Network, comprising pharmacy and hospital discharge records,\nrepresentative of 20 % of the Dutch population. The study population included patients aged 12 âË?â?? 60, with a\nGeneral Practice-recorded diagnosis for asthma (International Classification of Primary Care code R96), when\navailable, ââ?°Â¥2 prescriptions for asthma therapy at any time in their recorded history, and receiving first prescription\nof ICS therapy as either extrafine-particle (ciclesonide or hydrofluoroalkane beclomethasone dipropionate [BDP]) or\nfine-particle ICS (fluticasone propionate or non-extrafine-particle-BDP). Patients were matched (1:1) on relevant\ndemographic and clinical characteristics over 1-year baseline. Primary outcomes were severe exacerbation rates, risk\ndomain asthma control and overall asthma control during the year following first ICS prescription. Secondary\noutcomes, treatment stability and being prescribed higher versus lower category of short-acting Ã?²2 agonists (SABA)\ndose, were compared over a 1-year outcome period using conditional logistic regression models.\nResults: Following matching, 1399 patients were selected in each treatment cohort (median age: 43 years; males:\n34 %). Median (interquartile range) initial ICS doses (fluticasone-equivalents in Ã?¼g) were 160 (160 âË?â?? 320) for\nextrafine-particle versus 500 (250 âË?â?? 500) for fine-particle ICS (p < 0.001). Following adjustment for residual\nconfounders, matched patients prescribed extrafine-particle ICS had significantly lower rates of exacerbations\n(adjusted rate ratio [95 % CI], 0.59 [0.47ââ?¬â??0.73]), and significantly higher odds of achieving asthma control and\ntreatment stability in the year following initiation than those prescribed fine-particle ICS, and this occurred at lower\nprescribed doses. Patients prescribed extrafine-particle ICS had lower odds of being prescribed higher doses of\nSABA (0.50 [0.44ââ?¬â??0.57]).\nConclusion: In this historical, matched study, extrafine-particle ICS was associated with better odds of asthma\ncontrol than fine-particle ICS in patients prescribed their first ICS therapy in the Netherlands. Of importance, this\nwas reached at significantly lower prescribed dose.
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