title: Comparative effectiveness of budesonide-formoterol combination and fluticasone-salmeterol combination for asthma management: a United States retrospective database analysis.
abstract: BACKGROUND
  Comparative effectiveness of the budesonide-formoterol fumarate dihydrate combination (BFC) and the fluticasone propionate-salmeterol combination (FSC) therapy on asthma exacerbation has not been assessed in real-world settings in the United States.
  
  
  OBJECTIVE
  To compare exacerbation rates and health care utilization for patients with asthma who initiate BFC versus FSC therapy.
  
  
  METHODS
  This retrospective cohort comparative effectiveness study queried medical and pharmacy data for patients with asthma from a large managed care data repository that covers major US population centers. The patients were 12 to 64 years old, with ≥12 months of pre- and postindex enrollment and ≥1 pharmacy claim(s) for BFC or FSC initiated during June 1, 2007, and September 30, 2010; the first prescription fill date was defined as the index date. Patients with other respiratory diseases and/or cancer were excluded. Exacerbation was defined as asthma-related hospitalization, emergency department visit, and/or oral corticosteroid prescription fill. Cohorts were matched by using propensity scores.
  
  
  RESULTS
  A total of 3043 patients per cohort were matched and balanced. During the 12 months following the initiation the BFC cohort had lower adjusted exacerbations per person year versus the FSC cohort (0.85 vs 0.93; RR 0.92, 95% CI [0.85-0.99]), lower oral corticosteroid fill rates, and fewer asthma-related emergency department visits but comparable asthma-related hospitalization.
  
  
  CONCLUSIONS
  Asthma exacerbation was lower for BFC versus FSC initiators due to lower rates of oral corticosteroid use and asthma-related emergency department visits, which indicate better treatment effectiveness of those patients initiated with BFC compared with FSC.
authors.affiliation: HealthCore Inc, Wilmington, Del. Electronic address: otunceli@healthcore.com.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tunceli
authors.affiliation: Astra Zeneca LP, Gaithersburg, Md.
authors.forename: Setareh A
authors.initials: SA
authors.lastname: Williams
authors.affiliation: HealthCore Inc, Wilmington, Del.
authors.forename: David M
authors.initials: DM
authors.lastname: Kern
authors.affiliation: Astra Zeneca LP, Gaithersburg, Md.
authors.forename: Hanaa
authors.initials: H
authors.lastname: Elhefni
authors.affiliation: Astra Zeneca LP, Gaithersburg, Md.
authors.forename: Ned
authors.initials: N
authors.lastname: Pethick
authors.affiliation: Astra Zeneca LP, Molndal, Sweden.
authors.forename: Catrin
authors.initials: C
authors.lastname: Wessman
authors.affiliation: HealthCore Inc, Wilmington, Del.
authors.forename: Siting
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Astra Zeneca LP, Wilmington, Del.
authors.forename: Frank
authors.initials: F
authors.lastname: Trudo
mesh_terms: D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D057186:Comparative Effectiveness Research; D016208:Databases, Factual; D018450:Disease Progression; D004338:Drug Combinations; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital; D004983:Ethanolamines / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination; D000068759:Formoterol Fumarate; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006295:Health Resources; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000730:Androstadienes; D001993:Bronchodilator Agents; D004338:Drug Combinations; D004983:Ethanolamines; D000068297:Fluticasone-Salmeterol Drug Combination; D005938:Glucocorticoids; D019819:Budesonide; D000420:Albuterol; D000068759:Formoterol Fumarate
keywords: Asthma; Budesonide-formoterol combination; Comparative effectiveness; Fluticasone-salmeterol combination; Inhaled corticosteroids; Long-acting β(2)-adrenergic agonist; Retrospective cohort study; short-acting β(2)-adrenergic-agonists