JAIP:哮喘生物治疗依从性因给药环境而异

2022-06-09 小文子 MedSci原创

在某些情况下,专家访视始终与更好的生物治疗依从性相关。

靶向生物治疗已经成为中重度哮喘患者越来越重要的治疗选择。对于中重度哮喘患者,不同给药环境下哮喘生物制剂的依从性障碍可能不一致。The Journal of Allergy and Clinical Immunology: In Practice杂志发表了一项研究,调查了大型数据库来描述接受生物治疗的中重度哮喘患者特征的差异,按生物治疗给药环境(家庭、临床和混合)对患者进行分层;通过给药环境研究了与哮喘生物治疗依从性相关的因素;评估1年全因急诊就诊(医疗保健利用结局)是否与研究人群的生物制剂依从性相关。      

对2016年1月1日至2020年4月30日期间在Optum Clinformatics Data Mart接受初始生物治疗的中重度哮喘患者进行了回顾性研究。确定了三种给药环境:仅临床(门诊/输注中心)、家庭(自我给药)和混合环境(临床和自我给药的混合)。哮喘生物治疗依从性是在初始治疗后6个月内观察到的超过预期的生物剂量给药比例。使用泊松回归分析,通过给药环境确定与依从性相关的因素。使用Cox回归分析评估每种给药环境下1年全因急诊就诊与依从性之间的关系。

从2016年1月1日到2020年4月30日,3932例中重度哮喘患者接受了哮喘生物制剂治疗,符合纳入标准。其中,近四分之三(N=2898,73.7%)仅在临床环境,20%(N=786)在家庭环境,混合环境占6.3%(N=248)。与家庭(0.83[0.5,1])和混合(0.83[0.5,1])环境相比,仅临床环境的中位(0.75[0.5,1])生物制剂依从性相对较低。

家庭亚组显示人种和种族差异,与白人患者相比,黑人患者的依从率低16%(aRR= 0.84,95%CI:0.72~0.99),西班牙裔患者的依从率低13%(aRR = 0.87,95%CI:0.77~0.99)。该亚组中,依从率因保险类型而异,与商业保险患者相比,仅医疗保险患者(aRR = 0.74,95%CI:0.66~0.83)的依从率低26%。哮喘严重程度与较高的依从性相关,包括前6个月内专家访视(aRR = 1.14,95%CI:1~1.29)和呼吸道感染(aRR = 1.09,95%CI:1~1.18)。

在某些情况下,专家访视始终与更好的生物治疗依从性相关,而黑人人种、西班牙裔、较低的教育程度、仅医疗保险和较高的患者自付费用与较差的生物治疗依从性相关。在混合治疗环境中,1年全因急诊就诊风险随生物制剂依从性增加而降低。

哮喘生物治疗依从性因给药环境而异。改善哮喘生物治疗依从性的努力应考虑在有益时促进自我给药,改善专家访视,主要是针对依从性不佳风险较高的患者,尤其是黑人和西班牙裔患者。

原文出处:

Osazuwa-Peters OL, Greiner MA, Oberle A, Oakes M, Thomas SM, Bosworth H, Factors related to biologic adherence and outcomes among moderate-to-severe asthma patients, The Journal of Allergy and Clinical Immunology: In Practice (2022), doi: https://doi.org/10.1016/j.jaip.2022.05.022.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1951703, encodeId=100d1951e03b0, content=<a href='/topic/show?id=dcfc6458314' target=_blank style='color:#2F92EE;'>#治疗依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64583, encryptionId=dcfc6458314, topicName=治疗依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dab8203, createdName=zsyan, createdTime=Wed Dec 07 03:57:15 CST 2022, time=2022-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225522, encodeId=30691225522ec, content=坚持学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=杨海东, createdTime=Thu Jun 09 21:24:44 CST 2022, time=2022-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225510, encodeId=0f9e122551088, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Jun 09 20:51:33 CST 2022, time=2022-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225470, encodeId=887912254e011, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20230213/5855e9a7e85e4b808849362164402c52/25868520bd3e4851a7619202ec8728e2.jpg, createdBy=357c6553867, createdName=ms3000001005882169, createdTime=Thu Jun 09 17:16:10 CST 2022, time=2022-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225464, encodeId=26ac12254645e, content=学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f03a5433387, createdName=ms5000000518166734, createdTime=Thu Jun 09 16:36:01 CST 2022, time=2022-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1319368, encodeId=a70e1319368a9, content=<a href='/topic/show?id=60172686668' target=_blank style='color:#2F92EE;'>#依从性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26866, encryptionId=60172686668, topicName=依从性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9df476, createdName=fyxzlh, createdTime=Wed Jun 08 06:57:15 CST 2022, time=2022-06-08, status=1, ipAttribution=)]
    2022-06-09 杨海东

    坚持学习

    0

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    2022-06-09 yangchou

    好文章,谢谢分享。

    0

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    2022-06-09 ms3000001005882169

    学习了

    0

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    2022-06-09 ms5000000518166734

    学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习

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    2022-06-08 fyxzlh

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