Manon Belhassen

Costs of perennial allergic rhinitis and allergic asthma increase with severity and poor disease control

Perennial allergic rhinitis (PAR) represents a global and public health problem, due to its prevalence, morbidity, and impact on the quality of life. PAR is frequently associated with allergic asthma (AA). Costs of PAR with or without AA are poorly documented.

Recurrent Wheezing in Infants: A Population-Based Study.

AbstractRecurrent wheezing (RW) has a significant impact on infants, caregivers, and society, but morbidity and related medical resource utilization (MRU) have not been thoroughly explored. The burden of RW needs to be documented with population-based data. The objective was to assess the characteristics, medical management, and MRU of RW infants identified from national claims data.Infants aged from 6 to 24 months, receiving ≥2 dispensations of respiratory drugs within 3 months, and presenting a marker of poor control (index date), were selected. During the 6 months after index date, MRU was described in the cohort and among 3 subgroups with more severe RW, defined as ≥4 dispensations of respiratory drugs, ≥3 dispensations of oral corticosteroids (OCS), or ≥1 hospitalization for respiratory symptoms.A total of 115,489 infants had RW, corresponding to 8.2% of subjects in this age group. During follow-up, 68.7% of infants received inhaled corticosteroids, but only 1.8u200aU (unit) were dispensed over 6 months, suggesting discontinuous use. Control was mostly inadequate: 61.7% of subjects received OCS, 80.2% antibiotics, and 71.2% short-acting beta-agonists, and medical/paramedical visits were numerous, particularly for physiotherapy. Severe RW concerned 39.0% of the cohort; 32.8% and 11.7% of infants had repeated use of respiratory drugs and OCS, respectively, and 5.5% were hospitalized for respiratory symptoms.In this real-life nation-wide study, RW was common and infants had poor control and high MRU. Interventions are needed to support adequate use of controller therapy, and to improve medical care.

Inappropriate asthma therapy-a tale of two countries: a parallel population-based cohort study

Against recurrent controversies around the safety of short- and long-acting β2-agonists (SABA and LABA), and the National Review of Asthma Deaths inquiry in the United Kingdom, we investigated the prevalence of inappropriate therapy in asthma. Our study aimed to determine the prevalence of inappropriate use of asthma therapy in the United Kingdom and in France. Two interval, parallel, population-based cohorts (2007 and 2013) were developed in each country by using the UK OPCRD and the French EGB databases. Patients aged 6–40 years were studied over the 12-month period following inclusion, regarding overuse (⩾12 units) of SABA, use of LABA without inhaled corticosteroids (ICS) and ⩾2-fold higher use of LABA compared with that of ICS. Overall, 39,743 UK and 4,910 French patients were included in 2007, and 14,036 and 5,657 patients, respectively, were included in 2013. UK adults were more frequently exposed to SABA overuse compared with those in France in both periods, with an upward trend in the United Kingdom (P<0.05). In 2013, LABA use without ICS occurred in 0.1% and 1.5% of United Kingdom and French adults, respectively. Unbalanced use of LABA relative to ICS became marginal in both countries in 2013. Inappropriate use of therapy was less marked, but present, in children. Inappropriate therapy remains a common issue in asthma. Based on our figures, it may be estimated that >210,000 British and >190,000 French asthmatics aged 6–40 years were inappropriately treated in 2013.

Level of Asthma Controller Therapy Before Admission to the Hospital

BACKGROUNDnIn asthma, choice of controller therapy and adherence to treatment can affect the risk of future severe exacerbations leading to hospitalization.nnnOBJECTIVEnOur objective was to characterize treatment dispensation profiles before hospital admission for asthma.nnnMETHODSnUsing a 1/97th random sample of the national French claims data, patients with asthma aged 6 to 40 years were identified between 2006 and 2014. Patients with subsequent asthma-related hospitalization were selected. On the basis of controller therapy dispensed in the 12 months before admission, treatment profiles were categorized into clusters, using Wards minimum-variance hierarchical clustering method.nnnRESULTSnOf 17,846 patients with asthma, we identified 275xa0patients (1.5%) with an asthma-related hospitalization. Three distinct clusters were identified. The first cluster (63.6%) included patients with few dispensations of any controller medication (<1 unit). The second cluster (32.4%)xa0consisted of patients with frequent dispensations of long-acting beta agonists (LABAs)/inhaled corticosteroids (ICS) in fixed-dose combinations. The third cluster (4%)xa0comprised patients receiving free combinations of ICS and LABAs, with more dispensations of LABAs than ofxa0ICS.nnnCONCLUSIONSnIn France, before an asthma-related hospitalization, more than 60% of patients received little controller therapy and 4% were exposed to higher dispensation of LABAsxa0than of ICS. These results indicate that a largexa0fractionxa0of asthma-related hospitalizations can potentiallyxa0bexa0prevented with better pharmacotherapy.

Effectiveness of Montelukast on asthma control in infants: methodology of a French claims data study

BackgroundThis pilot study, conducted on a 1/97th representative sample of French claims data, prepared a project to assess the effectiveness of Montelukast (MTL-4) as add-on therapy for asthma in infants (6–24 months) compared to inhaled corticosteroids (ICS), based on real-world data. Due to the very recent opening of French claims data for effectiveness research, and the complex structure of this data source, we first tested the feasibility of identifying infants with asthma and outcome criteria, and the ability to perform relevant comparisons.MethodsWe identified a cohort of infants with uncontrolled asthma and receiving ≥2 consecutive dispensations of any respiratory drug (R03 ATC classification) during a 6-month period. Uncontrolled asthma was identified either from exacerbations or from markers of acute loss of asthma control; date of occurrence of an event (exacerbation and/or acute loss of asthma control) was defined as index date. The study groups comprised infants receiving MTL-4 +/− ICS (MTL-4 group) or ICS without MTL-4 (ICS group) at index date. These two groups were matched on gender, age, quarter of index date, therapy before index date, past asthma-related hospitalization (ever), and were followed for 6xa0months. The outcome was the rate of infants with uncontrolled asthma, defined as above.ResultsThis pilot cohort study included 1,149 infants with asthma (mean age 14.1xa0months, 64% boys). Of these, 51 and 768 were assigned to the MTL-4 and ICS groups, respectively. Uncontrolled asthma occurred in 78.8% and 78.4% of infants in these groups, respectively (oral corticosteroids were dispensed to 49% and 61%, respectively). Assessment of uncontrolled asthma, exposure to MTL-4 and ICS, and occurrence of outcomes were achieved. For the development of matching criteria, we defined a new marker of severity (therapeutic typologies).ConclusionThese data support the feasibility of the final project, to be conducted on claims data from the whole French population. We also showed that, with appropriate methodology and by using valid criteria, French claims data are an adequate resource for conducting comparative effectiveness studies in pediatric asthma. Finally, the algorithm used to identify infants with asthma could be applied to other studies using claims data.

Development of the International Severe Asthma Registry (ISAR): A Modified Delphi Study

BACKGROUNDnThe lack of centralized data on severe asthma has resulted in a scarcity of information about the disease and its management. The development of a common data collection tool for the International Severe Asthma Registry (ISAR) will enable standardized data collection, subsequently enabling data interoperability.nnnOBJECTIVESnTo create a standardized list of variables for the first international registry for severe asthma via expert consensus.nnnMETHODSnA modified Delphi process was used to reach consensus on a minimum set of variables to capture in ISAR: the core variables. The Delphi panel brought together 27 international experts in the field of severe asthma research. The process consisted of 3 iterative rounds. In each round, all Delphi panel members were issued an electronic ISAR Delphi workbook to complete and return to the ISAR Delphi administrator. Workbooks and result summaries were anonymously distributed by the Delphi administrator to all panel members at subsequent rounds. Finalization of the core variable list was facilitated by 2 face-to-face meetings.nnnRESULTSnOf the initial 747 selected variables, the Delphi panel reached a consensus on 95. The chosen variables will allow severe asthma to be assessed against patient demographics and medical history, patient-reported outcomes, diagnostic information, and clinical characteristics. Physician-reported outcomes such as nonadherence and information about treatment and management strategies will also be recorded.nnnCONCLUSIONSnThis is the first global attempt to generate an ISAR using a common set of core variables to ensure that data collected across all participating countries are standardized.

Impact of bisphosphonate compliance on the risk of osteoporotic fracture in France

SummaryLimited information is available on the impact of bisphosphonate compliance levels on fracture risk in osteoporosis patients in France. The results of this nested case-control, retrospective study suggest that fracture risk did not significantly change with bisphosphonate compliance levels, except for highly compliant patients.Purpose/introductionThis was the first study conducted in France to evaluate the impact of compliance levels for bisphosphonates, the most frequently prescribed first-line anti-osteoporotic treatment, on fracture risk.MethodsThis retrospective nested case-control study included patients ≥u200950xa0years old, who were recorded in a random sample of French claims data, did not die between 2006 and 2013, and received ≥u20091 reimbursement for anti-osteoporotic treatment between 2007 and 2013. Cases (patients hospitalised for osteoporosis-related fractures) were matched to 1–3 controls (patients hospitalised for other reasons). Patients hospitalised for fractures within 12xa0months preceding the first delivery of anti-osteoporotic treatment or during the first 24xa0months of follow-up were excluded. Bisphosphonate compliance during the 24xa0months preceding hospitalisation was calculated by the Continuous measure of Medication Acquisition version 7 (CMA7). We evaluated the impact of bisphosphonate compliance (CMA7u2009≥u200980%) and very good compliance levels (CMA7u2009>u200990%) on fracture risk.ResultsIn the main analysis, the mean CMA7 values during the 24xa0months preceding hospitalisation were 48.4% for the 434 cases and 51.3% for the 1123 age-matched controls. An adjusted conditional logistic regression showed no significant impact (odds ratio: 0.851 [95% confidence interval: 0.668, 1.084]) of bisphosphonate compliance on fracture occurrence. In the sensitivity analysis, including one randomly selected control per case and only controls with CMA7 values >u200990%, occurrence of fractures was lower (odds ratio: 0.741 [95% confidence interval: 0.608, 0.903]) among the 119 controls.ConclusionIn conclusion, this study suggested that very high levels of compliance with bisphosphonates are necessary to induce significant decreases in fracture risk.

PharmacoépidémiologieÉtude observationnelle sur l’adhésion précoce aux traitements hypotonisants anti-glaucomateuxEarly adherence to anti-glaucoma therapy: An observational study

OBJECTIVESnGlaucoma is a major cause of blindness, preventable by a regular therapy. Thus, a good knowledge of patients adherence to preventive therapy is critical to improve disease management. Early persistence to first-line glaucoma therapy is poorly documented in France. We verified to what extent first-line glaucoma therapy was interrupted within the 12 months following initiation and how this interruption varied with patients characteristics and drug classes.nnnMETHODSnPatients newly-treated with chronic glaucoma therapy (prostaglandins, beta-blockers alone or combined with another therapy, and topical carbonic anhydrase inhibitors) between 2005 and 2008 were identified in the French National Claims data (1/97th random sample). Twelve-month persistence was defined by the presence of the first-line drug class (≥1dispensation) between the 12th and 24th months following initiation. Twelve-month persistence was compared between patients according to the first-line drug classes and baseline characteristics. Proportion of days covered (12 months) and number of quarters with initiated drug class (24 months) were also studied.nnnRESULTSnAmong 5331 patients initiated with chronic glaucoma therapy in monotherapy (63% aged ≥60 years old, 57% females), initiated therapy mainly consisted of prostaglandins (43%) and beta-blockers alone (32%). Only 45% of the patients were persistent to first-line therapy 12 months after initiation. Salient differences in persistence rates appeared between drug classes (P<0.0001): from 59% with prostaglandins to 26% for topical carbonic anhydrase inhibitors. Better results also appeared for prostaglandins with other dimensions of adherence. Non-persistent patients were more likely younger than 40, or conversely aged≥80 (P<0.0001). They were also more likely to necessitate social assistance for therapy (P=0.0007). No salient difference appeared as to gender.nnnCONCLUSIONSnOur findings confirm the low early persistence of first-line therapy, despite better results for prostaglandins. Education of patients and identification of barriers to adherence could contribute to improve quality of care.