Inhaled corticosteroids plus formoterol associated with fewer asthma exacerbations

Maintenance and reliever therapy using inhaled corticosteroids and formoterol was associated with lower risk for asthma exacerbations, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

This strategy also reduced corticosteroid requirements, Chungsoo Kim, PharmD, a graduate student in the department of biomedical sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea, and colleagues wrote.

Current Global Initiative for Asthma guidelines recommend maintenance and reliever therapy (MART) comprising inhaled corticosteroids (ICS) and the long-acting beta 2 agonist (LABA) formoterol for managing adult asthma. However, the combination has rarely been evaluated using real-world data.

The researchers examined the records of adults with asthma aged 18 to 75 years who visited the Ajou University Medical Centre between January 2008 and July 2021.

The population included 296 patients treated with MART (mean age, 43.3 ± 15.7 years; 43.9% women; mean Charlson Comorbidity Index, 0.5 ± 0.6) and 950 patients treated with ICS, LABA and as-needed short-acting beta 2 agonist, or SABA (non-MART; mean age, 45.3 ± 15.7 years, 47.5% women; mean Charlson Comorbidity Index, 0.5 ± 1.8.).

Mean cumulative doses of chronic steroids totaled 445.2 mg/year for the non-MART group and 187.2 mg/year for the MART group at baseline. Also, 17.6% of the non-MART group and 11.6% of the MART group had a previous exacerbation.

Median duration of follow-up was 120 days (interquartile range [IQR], 60-439) in the MART group and 68 days (IQR, 60-315) in the non-MART group.

The patients in the MART group had a significantly lower risk for severe asthma exacerbations per 1,000 person-years than those in the non-MART group (incidence rate [IR], 64.8 vs. 199.6; HR = 0.39; 95% CI, 0.18-0.77).

Specifically, 94.8% of the MART group did not experience any severe asthma exacerbations, 4.8% experienced one or two, and 0.4% experienced three or more, which the researchers called significantly fewer events than the non-MART group (P < .01).

The MART group similarly had a significantly lower risk for asthma exacerbations of any severity per 1,000 person-years than the non-MART group (IR, 152 vs. 320.2; HR = 0.61; 95% CI, 0.37-0.99). In fact, the proportion of participants who experienced three or more exacerbations was higher in the non-MART group (P < .01).

However, the researchers did not find any difference in risks for hospitalization (HR = 0.88; 95% CI, 0.55-1.37) or for pneumonia (HR = 0.63; 95% CI, 0.03-4.51) between the two groups. The MART group experienced a 0.4% incidence of pneumonia, whereas the non-MART group experienced a 1% incidence, which the researchers said was not significantly different.

A greater proportion of the MART group vs. the non-MART group had an oral steroid prescription (45.9% vs. 33.8%; P < .01), although the non-MART group had twice the proportion of steroid injection compared with the MART group (12.3% vs. 6.06%; P = .01).

Additionally, the MART group had a lower cumulative corticosteroid dose (median, 190 mg/person-years; IQR, 97.9-420) than the non-MART group (median, 411 mg/person-years; IQR, 143.0-883.0; P < .01), with lower oral and injection types of doses as well.

Calling their study the first comprehensive analysis of real-world data on its clinical benefits, the researchers concluded that MART was more effective than ICS-LABA plus SABA therapy with significant reductions in risk for severe asthma exacerbations, asthma exacerbations and systemic corticosteroid requirements without increasing the risk for pneumonia.