Low-dose budesonide treatment reduces severe asthma-related events in patients with infrequent asthma symptoms at baseline

A post-hoc analysis of the start study

H. K. Reddel, W. W. Busse, Søren Pedersen, W. C. Tan, Y. Z. Chen, C. Jorup, D. Lythgoe, P. M. O'Byrne

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

Resumé

RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for reducing asthma-related exacerbation risk and mortality. Previously, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, for patients with less frequent symptoms, evidence is lacking for the benefit of ICS and safety of bronchodilator-only treatment. We investigated asthma outcomes by baseline symptom frequency in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years with recent-onset mild asthma (11 years] or 200 mug [patients aged 2 symptom days/week; further divided into 0-1, >1-2 symptom days/week). RESULTS: Overall, 7138 patients were included (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 symptom days/week for 2184 (30.6%), >1-2 for 3040 (42.6%) participants. Time to first SARE was longer for budesonide compared with placebo (hazard ratio: 0.57 [95% CI: 0.41, 0.79] for both 0-2 and >2 groups). SARE rates/1000 person-years over 3 years for budesonide versus placebo were 15.4 vs 23.5, 17.5 vs 26.2, and 20.2 vs 40.0 for Groups 0-1, >1-2, respectively. The rate of severe exacerbations identified by oral/systemic corticosteroid courses was lower for budesonide compared with placebo in all 3 symptom frequency groups (Figure). Patients treated with budesonide experienced significantly greater improvements in symptoms and significantly more symptom-free days compared with patients receiving placebo in all symptom frequency groups. CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment decreases the risk of SAREs and improves asthma symptoms in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0-1 days/week). (Figure Presented).
OriginalsprogEngelsk
ArtikelnummerA4175
TidsskriftAmerican Journal of Respiratory and Critical Care Medicine
Vol/bind191
Antal sider2
ISSN1073-449X
StatusUdgivet - 2015
BegivenhedATS 2015: American Thoracic Society - Denver, Colorado, USA
Varighed: 15. maj 201520. maj 2015

Konference

KonferenceATS 2015
LandUSA
ByDenver, Colorado
Periode15/05/201520/05/2015

Emneord

  • *asthma *low drug dose *human *patient *post hoc analysis *American *society risk therapy safety corticosteroid therapy mortality hazard ratio death emergency treatment hospital admission drug therapy *budesonide placebo corticosteroid steroid bronchodilating agent

Citer dette

@article{fe4663ba5121428e8933906dbb22663e,
title = "Low-dose budesonide treatment reduces severe asthma-related events in patients with infrequent asthma symptoms at baseline: A post-hoc analysis of the start study",
abstract = "RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for reducing asthma-related exacerbation risk and mortality. Previously, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, for patients with less frequent symptoms, evidence is lacking for the benefit of ICS and safety of bronchodilator-only treatment. We investigated asthma outcomes by baseline symptom frequency in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years with recent-onset mild asthma (11 years] or 200 mug [patients aged 2 symptom days/week; further divided into 0-1, >1-2 symptom days/week). RESULTS: Overall, 7138 patients were included (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 symptom days/week for 2184 (30.6{\%}), >1-2 for 3040 (42.6{\%}) participants. Time to first SARE was longer for budesonide compared with placebo (hazard ratio: 0.57 [95{\%} CI: 0.41, 0.79] for both 0-2 and >2 groups). SARE rates/1000 person-years over 3 years for budesonide versus placebo were 15.4 vs 23.5, 17.5 vs 26.2, and 20.2 vs 40.0 for Groups 0-1, >1-2, respectively. The rate of severe exacerbations identified by oral/systemic corticosteroid courses was lower for budesonide compared with placebo in all 3 symptom frequency groups (Figure). Patients treated with budesonide experienced significantly greater improvements in symptoms and significantly more symptom-free days compared with patients receiving placebo in all symptom frequency groups. CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment decreases the risk of SAREs and improves asthma symptoms in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0-1 days/week). (Figure Presented).",
keywords = "*asthma *low drug dose *human *patient *post hoc analysis *American *society risk therapy safety corticosteroid therapy mortality hazard ratio death emergency treatment hospital admission drug therapy *budesonide placebo corticosteroid steroid bronchodilating agent",
author = "Reddel, {H. K.} and Busse, {W. W.} and S{\o}ren Pedersen and Tan, {W. C.} and Chen, {Y. Z.} and C. Jorup and D. Lythgoe and O'Byrne, {P. M.}",
year = "2015",
language = "English",
volume = "191",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",

}

Low-dose budesonide treatment reduces severe asthma-related events in patients with infrequent asthma symptoms at baseline : A post-hoc analysis of the start study. / Reddel, H. K.; Busse, W. W.; Pedersen, Søren; Tan, W. C.; Chen, Y. Z.; Jorup, C.; Lythgoe, D.; O'Byrne, P. M.

I: American Journal of Respiratory and Critical Care Medicine, Bind 191, A4175, 2015.

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

TY - ABST

T1 - Low-dose budesonide treatment reduces severe asthma-related events in patients with infrequent asthma symptoms at baseline

T2 - A post-hoc analysis of the start study

AU - Reddel, H. K.

AU - Busse, W. W.

AU - Pedersen, Søren

AU - Tan, W. C.

AU - Chen, Y. Z.

AU - Jorup, C.

AU - Lythgoe, D.

AU - O'Byrne, P. M.

PY - 2015

Y1 - 2015

N2 - RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for reducing asthma-related exacerbation risk and mortality. Previously, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, for patients with less frequent symptoms, evidence is lacking for the benefit of ICS and safety of bronchodilator-only treatment. We investigated asthma outcomes by baseline symptom frequency in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years with recent-onset mild asthma (11 years] or 200 mug [patients aged 2 symptom days/week; further divided into 0-1, >1-2 symptom days/week). RESULTS: Overall, 7138 patients were included (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 symptom days/week for 2184 (30.6%), >1-2 for 3040 (42.6%) participants. Time to first SARE was longer for budesonide compared with placebo (hazard ratio: 0.57 [95% CI: 0.41, 0.79] for both 0-2 and >2 groups). SARE rates/1000 person-years over 3 years for budesonide versus placebo were 15.4 vs 23.5, 17.5 vs 26.2, and 20.2 vs 40.0 for Groups 0-1, >1-2, respectively. The rate of severe exacerbations identified by oral/systemic corticosteroid courses was lower for budesonide compared with placebo in all 3 symptom frequency groups (Figure). Patients treated with budesonide experienced significantly greater improvements in symptoms and significantly more symptom-free days compared with patients receiving placebo in all symptom frequency groups. CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment decreases the risk of SAREs and improves asthma symptoms in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0-1 days/week). (Figure Presented).

AB - RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for reducing asthma-related exacerbation risk and mortality. Previously, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, for patients with less frequent symptoms, evidence is lacking for the benefit of ICS and safety of bronchodilator-only treatment. We investigated asthma outcomes by baseline symptom frequency in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years with recent-onset mild asthma (11 years] or 200 mug [patients aged 2 symptom days/week; further divided into 0-1, >1-2 symptom days/week). RESULTS: Overall, 7138 patients were included (budesonide, n=3577; placebo, n=3561). At baseline, symptom frequency was 0-1 symptom days/week for 2184 (30.6%), >1-2 for 3040 (42.6%) participants. Time to first SARE was longer for budesonide compared with placebo (hazard ratio: 0.57 [95% CI: 0.41, 0.79] for both 0-2 and >2 groups). SARE rates/1000 person-years over 3 years for budesonide versus placebo were 15.4 vs 23.5, 17.5 vs 26.2, and 20.2 vs 40.0 for Groups 0-1, >1-2, respectively. The rate of severe exacerbations identified by oral/systemic corticosteroid courses was lower for budesonide compared with placebo in all 3 symptom frequency groups (Figure). Patients treated with budesonide experienced significantly greater improvements in symptoms and significantly more symptom-free days compared with patients receiving placebo in all symptom frequency groups. CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment decreases the risk of SAREs and improves asthma symptoms in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0-1 days/week). (Figure Presented).

KW - asthma low drug dose human patient post hoc analysis American society risk therapy safety corticosteroid therapy mortality hazard ratio death emergency treatment hospital admission drug therapy budesonide placebo corticosteroid steroid bronchodilating age

M3 - Conference abstract in journal

VL - 191

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

M1 - A4175

ER -