Results of a real-world study published in the Primary Care Respiratory Journal have shown that asthma patients may be switched from fluticasone propionate-salmeterol (FP-SAL) to extra-fine beclometasone-formoterol (efBDP-FOR) at an equivalent or lower inhaled corticosteroid (ICS) dosage with no reduction in clinical effectiveness but a significant reduction in cost to the NHS.1
The REACH (Real-world Effectiveness in Asthma therapy of Combination inHalers) study investigated the clinical and cost effectiveness of switching typical asthma patients from FP-SAL to efBDP-FOR. Results show that efBDP-FOR was non-inferior to FP-SAL (adjusted exacerbation rate ratio 1.01 (95% CI 0.74 to 1.37)). Additionally, switching to efBDP-FOR resulted in significantly better (p<0.05) odds of achieving overall asthma control (no asthma-related hospitalisations, bronchial infections, or acute oral steroids; salbutamol ≤200μg/day) and lower daily short-acting β2-agonist usage at a lower daily ICS dosage (mean - 130μg/day FP equivalents; p<0.001). It also reduced mean asthma- related healthcare costs by £93.63/patient/year (p<0.001).1
This real world study supports findings from randomised controlled trails which have shown that efBDP- FOR (24 μg/day) is as effective as FP-SAL in maintaining lung function in patients previously controlled with an equipotent dose of fluticasone plus salmeterol (500/100 μg/day),2 and that efBDP-FOR is as well tolerated as FP-SAL, with a comparable safety profile.3
Dr Dermot Ryan, General Practitioner, Respiratory Clinical Lead in the East Midlands and co-author of the study, commented, "This study shows that switching asthma patients from FP-SAL to efBDP-FOR not only achieves better outcomes, but can bring about cost savings. This should be very reassuring to General Practitioners seeking to optimise the care of their asthma patients, as it demonstrates that the benefits of switching that have been observed in randomised clinical trials, can be replicated in a real world setting."
In the UK, 5.4 million people are currently receiving treatment for asthma,4 comprising around 5.9% of the average practice list.5 Overall the NHS spends around £1 billion a year treating and caring for people with asthma,6 and NICE recommends that if a combination device is chosen then the least costly device that is suitable for an individual is recommended.7
About the REACH study
REACH is a retrospective matched (1:3) observational study of 1,528 asthma patients aged 18 - 80 years from clinical practice databases. Patients remaining on FP-SAL (n=1,146) were compared with those switched to efBDP-FOR at an equivalent or lower inhaled corticosteroid (ICS) dosage (n=382). Clinical and economic outcomes were compared between groups for the year before and after the switch. Non- inferiority of efBDP-FOR was tested against FP-SAL by comparing exacerbation rates during the outcome year.1 Using nationwide patient databases, the study authors sought to generate as large and representative a population of asthma patients as possible given the study aims, including patients with significant co- morbidities, a past or current smoking habit, and less than ideal adherence to their ICS prescriptions. The aims of the study were to determine whether efBDP-FOR is non-inferior to FP-SAL for exacerbation prevention when typical asthma patients are switched from FP-SAL to efBDP-FOR; and (2) to determine whether switching from FP-SAL to efBDP-FOR is cost-effective or represents a trade-off (lower cost but lower effectiveness).1 Primary outcome: Incidence of severe exacerbations in outcome year, Fostair was non-inferior to Seretide (patients ≥1 severe exacerbations 19.1% vs 19.9% respectively, adjusted exacerbation rate ratio 1.01 (95% CI 0.74 to 1.37)).1
- The odds of achieving overall asthma control (no asthma-related hospitalisations, no LRTI infections, no acute oral steroids, average daily SABA usage ≤200μg/day) was higher with Fostair than Seretide (patients with overall asthma control 31.2% vs 39.0% respectively, adjusted odds ratio 1.56 (95% CI 1.14 to 2.14), p<0.05)1
- Lower average daily SABA usage was achieved with Fostair compared to Seretide (patients with daily SABA use >200μg/day 52.1% vs 56.5% respectively, adjusted odds ratio 0.74 (95% CI 0.60 to 0.91), p<0.01)1
- Greater adherence to ICS therapy was seen with Fostair compared to Seretide (patients with ≥70% adherence 65.5% vs 57.4%, odds ratio 1.40 (95% CI 1.13 to 1.73), p<0.001)1
Chiesi Limited Medical Director, Dr Mark Bechter, commented: "The availability of real world data is essential in determining whether results from randomised studies are applicable to everyday practice. We're therefore delighted that REACH shows that patients can be switched from FP-SAL to efBDP-FOR without loss of clinical benefit, and for less overall cost."