| 1. |
- Franzen, S., et al.
(författare)
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Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study
- 2016
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Ingår i: Respiratory Research. - : Springer Science and Business Media LLC. - 1465-993X .- 1465-9921. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma. Methods: EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates. Results: We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N = 151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m(2) versus 27.3 kg/m(2); and consisted of 40% versus 34% males. Conclusions: The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.
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| 2. |
- Ekberg-Jansson, Ann, 1960, et al.
(författare)
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Budesonide inhaler device switch patterns in an asthma population in Swedish clinical practice (ASSURE)
- 2015
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Ingår i: International journal of clinical practice. - : Blackwell Publishing Ltd. - 1368-5031. ; 69:10, s. 1171-1178
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Tidskriftsartikel (refereegranskat)abstract
- Background Dry powder inhaler (DPI) device switch in asthma treatment could potentially increase with the entrance of new devices. We examined the switch patterns of budesonide (BUD) DPI analogues available in Sweden. Methods This observational real-life study linked primary healthcare medical records data from the Västra Götaland region to national Swedish registries, and included asthma patients (ICD-10-CM J45) prescribed BUD in a multidose DPI. Index date: first dispense of BUD DPI. Switch date: prescription of another BUD DPI device. Study outcomes (switch vs. non-switch) were exacerbations and prescription of short-acting β2-agonists. Study period was 1 July 2005 to 31 October 2013. Results Overall, 15,169 asthma patients were on treatment with BUD DPI; 1178 (7.35%) switched to another BUD DPI during the study. Pair-wise 1:1 matching of switchers vs. non-switchers resulted in two groups of 463 patients each (mean age 36 years, 55% female patients). A 25% higher exacerbation rate was seen postswitch (0.40 vs. 0.32; p = 0.047). Switchers were 4.5 year younger and had lower medication possession rate than non-switchers. Switch without primary healthcare visit did not differ between groups regarding consultations and exacerbations (no visit 4.96 and 0.90; visit 4.29 and 0.77, respectively). However, patients without primary healthcare visit at switch had significantly more outpatient hospital visits (2.01 vs. 0.81; p < 0.001). Conclusions Considering the low switch rate, asthma patients and physicians in Swedish general practice seem reluctant to switch to another BUD DPI device. Switch, especially without primary healthcare visit, was associated with decreased asthma control resulting in higher exacerbation rate and more outpatient hospital visits. © 2015 John Wiley & Sons Ltd.
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| 3. |
- Ekerljung, Linda, 1979, et al.
(författare)
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Prevalence, clinical characteristics and morbidity of the Asthma-COPD overlap in a general population sample
- 2018
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Ingår i: Journal of Asthma. - : Informa UK Limited. - 0277-0903 .- 1532-4303. ; 55:5, s. 461-469
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Although asthma and chronic obstructive pulmonary disease (COPD) have been regarded as distinct conditions, emerging literature suggests that overlapping phenotypes, called asthma-COPD overlap (ACO), exists. The aim of this study was to describe prevalence, patient characteristics and morbidity of ACO. Methods: From a cross-sectional population sample, the West Sweden Asthma Study, subjects with suspected asthma, chronic bronchitis or COPD, and a random sample, were invited to clinical examinations. ACO was defined as doctor-diagnosed asthma, or clear clinical signs of asthma at examination, with a FEV1/FVC < 0.7. Results: Subjects were categorized as ACO (N = 181), COPD only (N = 89), asthma only (N = 651) or healthy (n = 1036) based on clinical examinations. Prevalence of ACO was 3.4% in the random sample (N = 1172) and 18.1% among asthmatics (N = 138) in the random sample. Subjects with ACO (mean age 59 years, 54% women) had an age and gender distribution in between asthma only (45 years, 63% women) and COPD only (62 years, 41% women). Ever-smoking was reported by 71%, 48% and 74% in the ACO, asthma only and COPD only groups, respectively. Subjects with ACO had worse lung function (mean FEV1% of predicted normal 76%) than asthma only (100%) and COPD only (87%) and reported more respiratory symptoms. Also respiratory related emergency visits were more common in ACO compared to asthma only and COPD only, respectively. Conclusions: ACO is present in 3.4% of the population and common among subjects with both asthma and COPD. Subjects with ACO had worse lung function and more symptoms than subjects with asthma or COPD only.
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| 4. |
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| 5. |
- Dehlin, Mats, 1968, et al.
(författare)
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Factors associated with initiation and persistence of urate-lowering therapy
- 2017
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Ingår i: Arthritis Resarch and Therapy. - 1478-6354. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gout is the most common inflammatory arthritic disease and is caused by crystal deposition secondary to persistent hyperuricemia. Etiological treatment with urate-lowering therapy (ULT) has been available since the 1950s but previous studies have demonstrated suboptimal degree of treatment. In recent years we have seen recommendations for ULT earlier in the course of the disease, but there are few contemporary reports reflecting the current situation. Therefore we set out to investigate proportion receiving and persisting with ULT after gout diagnosis and predictors thereof. Method: A population-based cohort study using regional and national population-based registers. Cohort of patients (n = 7709) from western Sweden with incident gout aged 18 years and above from 2011 to 2013. An incident case of gout was defined as having been given a diagnosis of gout (ICD-10 M10, M14.0-14.1) not preceded by a gout diagnosis or a dispensation of ULT during the previous 5 years. Main outcome measures were cumulative incidence and predictors for start of, and persistence with, ULT in gout. Results: Within the first year after first gout diagnosis, 32% received ULT. Male sex, presence of diabetes or cardiovascular comorbidity, reduced kidney function but not diagnosed "end-stage kidney failure"increased the likelihood of receiving ULT. Of those starting ULT a majority (75%) did not persist with ULT treatment within the first 2 years. Age < 50 years, lack of comorbidities, and "normal kidney function"or "end-stage kidney failure"were associated with non-persistence with ULT. Conclusions: Only a minority of patients received ULT and a majority of these did not persist with treatment over the next 2 years. However, the older patients with renal impairment and comorbidities, possibly suffering from a more severe gout disease, were more likely to receive and persist with treatment. There is thus still room for considerable improvement with regards to management of ULT in gout.
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| 6. |
- Ekström, Magnus, et al.
(författare)
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Oral corticosteroid use, morbidity and mortality in asthma: A nationwide prospective cohort study in Sweden
- 2019
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Ingår i: Allergy: European Journal of Allergy and Clinical Immunology. - : Wiley. - 0105-4538 .- 1398-9995. ; 74:11, s. 2181-2190
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patterns and determinants of long-term oral corticosteroid (OCS) use in asthma and related morbidity and mortality are not well-described. In a nationwide asthma cohort in Sweden, we evaluated the patterns and determinants of OCS use and risks of OCS-related morbidities and mortality. Methods: Data for 217993 asthma patients (aged≥6years) in secondary care were identified between 2007 and 2014 using Swedish national health registries. OCS use at baseline was categorized: regular users (≥5mg/d/y; n=3299; 1.5%); periodic users (>0 but <5mg/d/y; n=49930; 22.9%); and nonusers (0mg/d/y; n=164765; 75.6%). Relative risks of becoming a regular OCS user and for morbidity and mortality were analysed using multivariable Cox regression. Results: At baseline, 24% of asthma patients had used OCS during the last year and 1.5% were regular users. Of those not using OCS at baseline, 26% collected at least one OCS prescription and 1.3% became regular OCS users for at least 1year during the median follow-up of 5.3years. Age at asthma diagnosis, increasing GINA severity and Charlson Comorbidity Index were associated with regular OCS use. Compared to periodic and non-OCS use, regular use was associated with increased incidence of OCS-related morbidities and greater all-cause mortality, adjusted HR 1.34 (95% CI 1.24-1.45). Conclusions: Oral corticosteroids use is frequent for asthma patients, and many are regular users. Regular OCS use is associated with increased risk of morbidity and mortality. These findings indicate that there is a need of other treatment options for patients with severe asthma who are using regular OCS. © 2019 The Authors Allergy Published by John Wiley & Sons Ltd
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| 7. |
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| 8. |
- Jansson, Sven-Arne, et al.
(författare)
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Health care consumption and HRQOL in severe asthma in Sweden
- 2017
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Ingår i: Value in Health. - : ELSEVIER SCIENCE INC. - 1098-3015 .- 1524-4733. ; 20:9, s. A513-A513
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Severe asthma is a disabling and costly disease, often poorly controlled despite high-dosage controller medications. The objectives of this analysis were to estimate health care consumption and to investigate health-related quality of life (HRQOL) in a severe asthma cohort, derived from a large-scale population survey in northern Sweden. Methods: Severe asthma was defined by US SARP criteria; high-dosage inhaled corticosteroids (ICS) by GINA 2014 criteria. In total, 32 patients with severe asthma were invited to a clinical examination and structured interview. Retrospective data of all asthma-related direct and indirect resource consumption during the last year were collected following a defined protocol. HRQOL was assessed by four patient-reported outcome measures: two general measures (SF-36; EQ-5D) and two disease-specific measures (SGRQ; ACT). The cohort was divided into two groups —patients with (OCS) or without maintenance oral corticosteroid (non-OCS) treatment. Results: Health care resource utilization was greater in the OCS-group compared with the non-OCS group. Mean annual number of visits to specialist care was 2.0 in the OCS group vs. 0.5 visits in the non-OCS group. Four patients in the OCS group had early retirement vs. none in the non-OCS group. HRQOL was worse in the OCS group, both when measured with general and disease-specific instruments. The Mental and Physical Component Summary scores of the SF-36 in the OCS vs. non-OCS group were 50.1 vs. 40.7 and 55.8 vs. 44.4, respectively. Similarly, the total SGRQ scores indicated worse HRQOL for the OCS-group compared with the non-OCS group (37.0 vs. 27.0). Conclusions: In this severe asthma population, patients treated with maintenance OCS consumed more health care resources, were more frequently early retired, and had worse HRQOL compared with those not receiving maintenance OCS. The results indicate a need for improved treatment for patients with severe asthma on maintenance OCS. Sponsor: AstraZeneca.
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