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Real-world evidence for the maintenance and reliever therapy of ICS-formoterol

Published: June 22, 2022

Asthma is a common chronic airway disease that affects more than 350 million people worldwide. Successful asthma management requires selecting appropriate medications, which could improve asthma control and quality of life. Inhaled corticosteroids (ICS)-long-acting beta 2 agonist (LABA) combination therapy, as a key component of maintenance medication, improves airway inflammation and lung function. Furthermore, a treatment regimen that used inhaled corticosteroid-formoterol (ICS-formoterol) for both maintenance and reliever therapy (MART) was validated for mild and moderate-to-severe asthmatics in clinical trials. The Global Initiative for Asthma (GINA) introduced the MART strategy in their clinical guideline based on clinical efficacy, however, data regarding its long-term clinical effectiveness is still sparse. The MART strategy should be evaluated in a real-world clinical setting for clear advantages over the conventional ICS-LABA plus a short-acting beta-2 agonist (SABA) approach in terms of key outcomes such as asthma exacerbation or systemic corticosteroid requirement.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Kim et al. investigated the effectiveness of the MART strategy for asthmatic patients. Risks of mild and severe asthma exacerbation, hospitalization, and pneumonia as well as the annual systemic steroid requirement were compared between the MART group and the non-MART group using ICS-LABA plus SABA. All analyses were conducted using an electronic health records database, which reflects routine care in the real-world practice. For controlling bias from confounding, all comparisons were analyzed within matched pairs (based on propensity score), and sensitivity analyses with various analytic designs were also conducted to confirm the validity of the results.

The MART strategy using ICS-formoterol was associated with a lower risk of asthma exacerbation and reduced corticosteroid requirement. The risk of mild and severe asthma exacerbation was significantly lower in the MART group than in the non-MART group (39% and 61% lower in the MART group, respectively). Corticosteroid requirements were lower in the MART group than in the non-MART group (median 190.0 versus 411.0 mg/person-year, respectively). In addition, the risk of pneumonia was not elevated with the extra use of ICS. These findings support the current GINA guideline which recommends single ICS-formoterol spray use as a preferred option for both maintenance and reliever.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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