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Adjustment methods for corticosteroid therapy similar for patients with asthma
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Neither biomarker- nor symptom-based adjustment of corticosteroids was more effective than physician assessment-based adjusted therapy in time to treatment failure among adult patients with asthma in a recent study.
In a parallel, placebo-controlled study, researchers randomly assigned 342 adults with mild to moderate asthma who received low-dose inhaled corticosteroid therapy to either physician assessment-based adjustment (PABA, n=114), biomarker-based adjustment (BBA, n=115) or symptom-based adjustment (SBA, n=113). The 9-month Best Adjustment Strategy for Asthma in the Long Term trial was conducted at 10 academic medical centers across the US.
PABA and BBA patients had their treatments adjusted every 6 weeks, with the BBA cohort’s adjustments based on exhaled nitric oxide. SBA patients received their therapy whenever they needed albuterol as rescue medication. Researchers established the time to treatment failure, or clinical worsening of patients’ asthma, as the primary outcome.
Hazard ratios of PABA vs. BBA and PABA vs. SBA were 1.2 (0.6-2.3) and 1.6 (0.8-3.30), respectively, and not statistically significant. BBA vs. SBA had an HR of 1.4 (0.6-2.9) with 97.5% CI for each. Time to treatment failure, measured by Kaplan-Meier survival plots, also was similar among the groups: PABA (22%, 14%-33%, 24 events), BBA (20%, 13%-30%, 21 events) and SBA (15%, 9%-25%, 16 events) (all 97.5% CI).
Asthma exacerbations, the mean proportion of treatment failures that progressed to exacerbations, and measurements of lung function and asthma symptoms did not differ significantly between treatment groups.
“Our findings provide reassurance that SBA of inhaled corticosteroids dose may be appropriate in most patients with mild to moderate asthma,” the researchers concluded. “Neither the SBA nor the BBA strategy for inhaled corticosteroid therapy was superior to the standard PABA strategy for the outcome of treatment failure.”
Disclosure: See the study for a full list of relevant disclosures.