Real-world Effectiveness and Cost-effectiveness of Leading Inhaled Corticosteroids in Asthma Management

NCT ID: NCT01141439

Last Updated: 2013-03-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

815377 participants

Study Classification

OBSERVATIONAL

Study Start Date

2001-01-31

Study Completion Date

2010-07-31

Brief Summary

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The objective of the study was to compare the effectiveness, cost-effectiveness and direct healthcare costs of managing asthma in patients with evidence of persistent asthma, following the initiation and increased dose of inhaled corticosteroid (ICS) therapy using HFA-BDP (Qvar®) (either as initial therapy or as a step-up therapy) compared with the most commonly prescribed alternative ICS in the UK, CFC-beclometasone (BDP) and fluticasone (FP) as metered dose inhalers (MDIs). Qvar vs FP analyses were split between adults (12-60yrs) and paediatrics (5-11yrs).

Detailed Description

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While current UK asthma guidelines are underpinned with evidence from RCTs, much of this evidence has been undertaken in patients who are not representative of the majority of the current UK asthma population. In fact it has been estimated that fewer than 10% of the patients seen in everyday clinical practice would be eligible for inclusion in such trials. The poor representation of the asthma population is due to a number of factors, such as tightly-controlled inclusion criteria for RCTs. There is therefore a need for more representative RCTs and real-life and observational studies to inform existing guidelines and help optimise asthma outcomes. A more holistic approach to respiratory research would see RCT evidence complimented by "real-life" data from pragmatic trials and observational studies.

A number of trends are emerged in asthma prescribing that warrant further investigation to ascertain their benefit to both the patient and the NHS. In particular, significant pressure exists to use the cheapest inhaler devices and formulations. An analysis of a pragmatic trial of Qvar versus standard CFC-BDP undertaken by Research in Real Life suggested that Qvar may be offer greater effectiveness in.5,6 In light of these data, the following report details the findings of a study designed to examine the effectiveness of Qvar in real-life clinical practice using the General Practice Research Database (GPRD).

Conditions

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Asthma

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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IPDI HFA-BDP MDI

Patients who commenced inhaled corticosteroid therapy as HFA-BDP via MDI

Extra-fine hydrofluoroalkane-beclomethasone dipropionate

Intervention Type DRUG

Initiation of HFA-BDP (any dose) in steroid naive patients via MDI

IPDI FP MDI

Patients who commenced inhaled corticosteroid therapy as FP via MDI

fluticasone propionate

Intervention Type DRUG

Initiation of FP (any dose) via MDI in steroid naive patient

IPDA FP MDI

Patients who had a step up in inhaled corticosteroid therapy as FP via MDI

Fluticasone propionate

Intervention Type DRUG

An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as FP via MDI

IPDA HFA-BDP MDI

Patients who had a step up in inhaled corticosteroid therapy as HFA-BDP via MDI

Extra-fine hydrofluoroalkane-beclomethasone dipropionate

Intervention Type DRUG

An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as HFA-BDP via MDI

IPDI CFC-BDP MDI

Patients who commenced inhaled corticosteroid therapy as CFC-BDP via MDI

Chlorofluorocarbon beclomethasone dipropionate

Intervention Type DRUG

Initiation of CFC-BDP (any dose) via MDI in steroid naive patient

IPDA CFC-BDP MDI

Patients who had a step up in inhaled corticosteroid therapy as CFC-BDP via MDI

Beclomethasone dipropionate

Intervention Type DRUG

An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as CFC-BDP via MDI

Interventions

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Extra-fine hydrofluoroalkane-beclomethasone dipropionate

Initiation of HFA-BDP (any dose) in steroid naive patients via MDI

Intervention Type DRUG

Extra-fine hydrofluoroalkane-beclomethasone dipropionate

An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as HFA-BDP via MDI

Intervention Type DRUG

Fluticasone propionate

An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as FP via MDI

Intervention Type DRUG

Beclomethasone dipropionate

An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as CFC-BDP via MDI

Intervention Type DRUG

fluticasone propionate

Initiation of FP (any dose) via MDI in steroid naive patient

Intervention Type DRUG

Chlorofluorocarbon beclomethasone dipropionate

Initiation of CFC-BDP (any dose) via MDI in steroid naive patient

Intervention Type DRUG

Other Intervention Names

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Qvar® Qvar

Eligibility Criteria

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Inclusion Criteria

Included patients must:

* aged 5-60 years
* evidence of asthma: a diagnostic code of asthma or ≥2 prescriptions for asthma in baseline year at different points in time including one of ICS
* on current therapy at the IPD, defined as ≥1 ICS script and ≥1 other asthma prescriptions in the 12 months prior to first change in therapy
* had definite dosing instructions
* have at least 1 year of up-to-standard (UTS) baseline data before IPD
* have at least 1 year of UTS outcome data after IPD.

Exclusion Criteria

* had a diagnostic read code for chronic obstructive pulmonary disease (COPD) at any time
* had a diagnostic read code for chronic respiratory disease at any time
* For the therapy increase patient cohort, any patients receiving a combination inhaler in addition to their separate ICS inhaler in the year prior to IPD were also excluded.
Minimum Eligible Age

5 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Teva Branded Pharmaceutical Products R&D, Inc.

INDUSTRY

Sponsor Role collaborator

Research in Real-Life Ltd

NETWORK

Sponsor Role lead

Responsible Party

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Research in Real Life Limited

Principal Investigators

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David Price, Prof. MD

Role: PRINCIPAL_INVESTIGATOR

Company Director

Alison Chisholm, MSc

Role: STUDY_DIRECTOR

Research Project Director

Locations

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General Practice Research Database

London, London, United Kingdom

Site Status

Countries

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United Kingdom

References

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Herland K, Akselsen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger "real life" population of patients with obstructive lung disease? Respir Med. 2005 Jan;99(1):11-9. doi: 10.1016/j.rmed.2004.03.026.

Reference Type BACKGROUND
PMID: 15672843 (View on PubMed)

Travers J, Marsh S, Caldwell B, Williams M, Aldington S, Weatherall M, Shirtcliffe P, Beasley R. External validity of randomized controlled trials in COPD. Respir Med. 2007 Jun;101(6):1313-20. doi: 10.1016/j.rmed.2006.10.011. Epub 2006 Nov 17.

Reference Type BACKGROUND
PMID: 17113277 (View on PubMed)

Thomas M, Cleland J, Price D. Database studies in asthma pharmacoeconomics: uses, limitations and quality markers. Expert Opin Pharmacother. 2003 Mar;4(3):351-8. doi: 10.1517/14656566.4.3.351.

Reference Type BACKGROUND
PMID: 12614187 (View on PubMed)

Tannen RL, Weiner MG, Xie D. Use of primary care electronic medical record database in drug efficacy research on cardiovascular outcomes: comparison of database and randomised controlled trial findings. BMJ. 2009 Jan 27;338:b81. doi: 10.1136/bmj.b81.

Reference Type BACKGROUND
PMID: 19174434 (View on PubMed)

Juniper EF, Price DB, Stampone PA, Creemers JP, Mol SJ, Fireman P. Clinically important improvements in asthma-specific quality of life, but no difference in conventional clinical indexes in patients changed from conventional beclomethasone dipropionate to approximately half the dose of extrafine beclomethasone dipropionate. Chest. 2002 Jun;121(6):1824-32. doi: 10.1378/chest.121.6.1824.

Reference Type BACKGROUND
PMID: 12065345 (View on PubMed)

Price D, Haughney J, Duerden M, Nicholls C, Moseley C. The cost effectiveness of chlorofluorocarbon-free beclomethasone dipropionate in the treatment of chronic asthma: a cost model based on a 1-year pragmatic, randomised clinical study. Pharmacoeconomics. 2002;20(10):653-64. doi: 10.2165/00019053-200220100-00002.

Reference Type BACKGROUND
PMID: 12162754 (View on PubMed)

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8.

Reference Type BACKGROUND
PMID: 3558716 (View on PubMed)

Cliniclue [homepage on the internet]. The Clinical Information Consultancy CLINICLUE® [updated 2008; cited 15 May 2009]. Available online at: http://www.cliniclue.com

Reference Type BACKGROUND

SPSS [homepage on the internet]. Chicago: SPSS Inc [updated 2009; cited 15 May 2009]. Available online at: http://www.spss.com/UK/

Reference Type BACKGROUND

Microsoft office online [homepage on the internet]. USA: Microsoft Corporation [updated 2009; cited 15 May 2009]. Available online at: http://office.microsoft.com/excel

Reference Type BACKGROUND

STATA: Data Analysis and Statistical Software [homepage on the internet]. Texas: STATA [updated 2009; cited 15 May 2009]. Available online at: http://www.stata.com/

Reference Type BACKGROUND

Related Links

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http://www.optimumpatientcare.org

Optimum Patient Care is the Research in Real Life's sister company (a social enterprise organisation)

Other Identifiers

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BA4

Identifier Type: -

Identifier Source: org_study_id

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