Short-acting beta2-agonist and systemic/inhaled corticosteroid exposures in us adolescents and adults with asthma

IntroductionAlthough adolescents are often under-represented in asthma clinical trials, expert opinion therapy recommendations typically include adolescents with adults. We assessed short-acting beta2-agonist (SABA) and corticosteroid (systemic [SCS] and inhaled [ICS] exposures in adolescents and adults with asthma to understand age-related similarities and differences.MethodsMerative MarketScan Research databases (2010-2017) for US patients ≥12 years receiving SABA for asthma were evaluated. Patients were indexed on a random SABA fill and had post-index year claims for ≥1 maintenance and/or SABA. Post-index SCS and ICS exposures and cumulative SCS use relative to SABA fills were compared for patients 12–17 versus ≥18 years (unadjusted t-test, comparison of proportions, 2-way Chi-square: p≤0.05).Results727,932 patients were analyzed: 187,847 adolescents (mean [SD] age 14.3 [1.7] years; 45.1% female; 33.7% had 1, 42.1% 2–3, and 24.2% ≥4 SABA claims) and 540,085 adults (age 44.3 [15.3] years; 67% female; 42.0% had 1, 33.7% 2–3, and 24.2% ≥4 SABA claims). Overall, 40.3% of adolescents and 47.2% of adults filled SCS†, of these patients with SCS fills, 47.6% and 48.1%, respectively, filled ICS†. A higher proportion of adults than adolescents experienced SCS exposures at each SABA-claim level, but for both increasing SABA was associated with increasing SCS exposures of 500–<1000 and ≥1000 mg (Figure 1A). Although adults had greater SCS/ICS exposures than adolescents (Figure 1B), both increased ICS use during concurrent SCS use.ConclusionAmong both adolescents and adults, >40% received SCS/year and ∼1 in 4 had ≥4 SABA/year; ICS use increased during SCS exposure.