Maintenance OCS Were Used More Frequently Than Biologics in Patients with Uncontrolled GINA 4/5 Asthma in Germany in 2019.

IF 3.7 3区医学 Q2 ALLERGY Journal of Asthma and Allergy Pub Date : 2024-11-01 eCollection Date: 2024-01-01 DOI:10.2147/JAA.S480380

Katrin Milger, Dirk Koschel, Dirk Skowasch, Hartmut Timmermann, Olaf Schmidt, Karl-Christian Bergmann, Claus Neurohr, Robert Lindner, Sebastian Heck, Johann Christian Virchow

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Abstract

Purpose: Asthma is affecting 4-5% of all adults (10% of children) in Germany, ≥ half are inadequately controlled. In 2019 up to 54 thousand patients suffered from severe uncontrolled asthma, 52% were treated/co-treated by pneumonologists. 45% of them had continuous oral corticosteroid (OCS)- and short-acting β2-agonist (SABA) overuse for ≥2 years. The aim of the current study was to analyze the main treatments, escalation schemes and the adherence to the GINA recommendations.

Patients and methods: Retrospective analysis in 2021 based on data from January to December 2019 in Germany, using the IQVIA™ LRx prescription database and the IQVIA™ Disease Analyzer database containing anonymized electronic medical records as the main data sources.

Results: In 2019 25,200 patients with severe, uncontrolled asthma treated in a pneumonologist´s practice in Germany received GINA 3 (0,4%), GINA 4 (76%) or GINA 5 therapy (24%) during the study year compared to 59% GINA 5 therapy in the 5-10% (1,500-3,000) co-treated in a specialized outpatient department. In Pneumonologists` practices the most frequent choice in GINA 5 was OCS in 69% of patients (biologicals 37%, long-acting muscarinic antagonist (LAMA) 20%) compared to 66% biologicals, 55% OCS, and 25% LAMA in the outpatient department. 54,958 of 613,000 GINA 4/5 patients were treated with OCS, 9,725 even with doses above the so called "Cushing threshold" for prednisolone of 2700 mg/year. After introduction of a biological treatment, patients reduced their SABA prescriptions by 28%, OCS by 55%, and OCS overall exposure by 40%, one-third did not need OCS anymore.

Conclusion: In 75% of patients with uncontrolled asthma for ≥2 years therapy was not escalated beyond GINA 4 or low dose OCS was used as the most frequent add-on treatment in GINA 5 contradictory to treatment recommendations. Use of biologics reduced on demand rescue medication and OCS use.

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2019年，德国未受控制的GINA 4/5哮喘患者使用维持性OCS的频率高于生物制剂。

目的：在德国，4-5%的成年人（10%的儿童）患有哮喘，其中≥一半的患者病情未得到充分控制。2019 年，有多达 5.4 万名患者患有严重失控的哮喘，其中 52% 接受了肺科医生的治疗/联合治疗。其中45%的患者已连续过度使用口服皮质类固醇（OCS）和短效β2-激动剂（SABA）≥2年。本研究旨在分析主要治疗方法、升级方案以及对GINA建议的遵守情况：2021年的回顾性分析基于德国2019年1月至12月的数据，使用IQVIA™ LRx处方数据库和包含匿名电子病历的IQVIA™ Disease Analyzer数据库作为主要数据来源：2019年，德国有2.52万名严重、未得到控制的哮喘患者在肺科医生的诊所接受了GINA 3（0.4%）、GINA 4（76%）或GINA 5（24%）治疗，而在专科门诊接受联合治疗的5%-10%（1500-3000人）患者中，59%接受了GINA 5治疗。在肺科医生的临床实践中，69% 的患者在 GINA 5 治疗中最常选择的是 OCS（生物制剂占 37%，长效毒蕈碱拮抗剂 (LAMA) 占 20%），而在门诊部，生物制剂占 66%，OCS 占 55%，LAMA 占 25%。在 613,000 名 GINA 4/5 患者中，54,958 人接受了 OCS 治疗，9,725 人的剂量甚至超过了泼尼松龙 2700 毫克/年的所谓 "库欣阈值"。在采用生物疗法后，患者的 SABA 处方减少了 28%，OCS 减少了 55%，OCS 的总接触量减少了 40%，三分之一的患者不再需要 OCS：结论：75%的哮喘患者在≥2 年的时间里病情未得到控制，其治疗未超过 GINA 4 级，或者在 GINA 5 级中，小剂量 OCS 被用作最常用的附加治疗，这与治疗建议相悖。生物制剂的使用减少了按需抢救药物和 OCS 的使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Asthma and Allergy Medicine-Immunology and Allergy

CiteScore

5.30

自引率

6.20%

发文量

185

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.