Symptom control in patients with asthma using inhaled corticosteroids/long-acting β2-agonists (fluticasone furoate/vilanterol or budesonide/formoterol) in the US: a retrospective matched cohort study

Treatment with fluticasone furoate/vilanterol (FF/VI), an inhaled corticosteroid/long-acting β2-agonist therapy, reduces the risk of severe asthma exacerbations and improves lung function and symptom control in patients with asthma. However, real-world data remain limited among asthma patients in the United States (US). This retrospective cohort study propensity score (PS) matched adult asthma patients initiating once-daily FF/VI 100/25 mcg with patients initiating twice-daily budesonide/formoterol (B/F) 160/4.5 mcg using a US claims database (January 1, 2015–December 31, 2018). Asthma control was measured by the mean number of short-acting β2-agonist (SABA) canisters dispensed per patient-year (PPY) during follow-up. Time to first, and rates of, overall and severe asthma exacerbations were also measured. After PS matching, 18,531 patients receiving FF/VI were matched to 18,531 patients receiving B/F. Mean SABA canisters dispensed PPY was significantly lower for FF/VI users compared with B/F users (FF/VI: 1.47, B/F: 1.64; p p p = 0.027). Asthma-related exacerbation rates per 100 patient-days were also significantly lower for the FF/VI group compared with the B/F group (overall: 0.0475 vs. 0.0558, p p = 0.020). In real-world practice, initiation of once-daily FF/VI 100/25 mcg in adults with asthma was associated with lower use of SABA and fewer asthma-related exacerbations, which may indicate better asthma control, when compared with use of twice-daily B/F 160/4.5 mcg.糠酸氟替卡松/维兰特罗（fluticasone furoate/vilanterol, FF/VI）作为吸入性糖皮质激素/长效β₂受体激动剂联合治疗方案，可降低哮喘患者严重急性加重风险，改善肺功能并优化症状控制。然而，美国哮喘患者的真实世界相关研究数据仍较为匮乏。本研究为回顾性队列研究，基于2015年1月1日至2018年12月31日的美国医疗理赔数据库，通过倾向评分（propensity score, PS）匹配，将起始每日一次100/25μg FF/VI治疗的成年哮喘患者，与起始每日两次160/4.5μg布地奈德/福莫特罗（budesonide/formoterol, B/F）治疗的患者进行配对。哮喘控制情况以随访期间每名患者年（patient-year, PPY）配发的短效β₂受体激动剂（short-acting β₂-agonist, SABA）处方罐数的均值进行评估，同时记录首次哮喘急性加重的时间、总体及严重哮喘急性加重的发生率。经倾向评分匹配后，共纳入18531例接受FF/VI治疗的患者，与18531例接受B/F治疗的患者完成匹配。结果显示，FF/VI使用者的每名患者年短效β₂受体激动剂处方罐数均值显著低于B/F使用者（FF/VI组：1.47，B/F组：1.64；p=0.027）。每100患者日的哮喘相关急性加重发生率，FF/VI组同样显著低于B/F组（总体发生率：0.0475 vs 0.0558，p=0.020）。本研究结果表明，在真实世界临床实践中，与每日两次160/4.5μg B/F治疗相比，成年哮喘患者起始每日一次100/25μg FF/VI治疗可降低短效β₂受体激动剂使用量，减少哮喘相关急性加重事件，提示哮喘控制效果更优。