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AsthmaQvarAsthmaNCT01141439

Real-world Effectiveness and Cost-effectiveness of Leading Inhaled Corticosteroids in Asthma Management

An observational study of Asthma, run by Research in Real-Life Ltd at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The objective of the study was to compare the effectiveness, cost-effectiveness and direct healthcare costs of managing asthma in patients with evidence of persistent asthma, following the initiation and increased dose of inhaled corticosteroid (ICS) therapy using HFA-BDP (Qvar®) (either as initial therapy or as a… Read more about this study

Who is it for?
Ages 5 to 60 years
Conditions the study is for
Asthma
What is being tested?
Extra-fine hydrofluoroalkane-beclomethasone dipropionate, Fluticasone propionate and Beclomethasone dipropionate
How many people
815,377 participants
Where
1 siteUnited Kingdom
Study dates
Jan 2001to Jul 2010
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 5 to 60 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Study population: Primary care asthma patients receiving who either initiated ICS therapy as any of extrafine HFA-BDP, CFC-BDP of FP via MDI at an index prescription date (IPD), or were on existing ICs therapy (any) and had an increase in ICS dose at IPD as any of extrafine HFA-BDP, CFC-BDP of FP via MDI

Who may be able to join

  • Included patients must:
  • aged 5-60 years
  • evidence of asthma: a diagnostic code of asthma or ≥2 prescriptions for asthma in baseline year at different points in time including one of ICS
  • on current therapy at the IPD, defined as ≥1 ICS script and ≥1 other asthma prescriptions in the 12 months prior to first change in therapy
  • had definite dosing instructions
  • have at least 1 year of up-to-standard (UTS) baseline data before IPD
  • have at least 1 year of UTS outcome data after IPD.

Who cannot join

  • had a diagnostic read code for chronic obstructive pulmonary disease (COPD) at any time
  • had a diagnostic read code for chronic respiratory disease at any time
  • For the therapy increase patient cohort, any patients receiving a combination inhaler in addition to their separate ICS inhaler in the year prior to IPD were also excluded.

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • General Practice Research Database

    London, London, SW8 5NQ

Other trials in United Kingdom

About this study

Official title: A Retrospective Evaluation of the Effectiveness and Cost-effectiveness of HFA-BDP MDI (Qvar®) Compared With CFC-BDP MDI and FP MDI Used in the Management of Asthma in a Representative UK UK Primary Care Population

The objective of the study was to compare the effectiveness, cost-effectiveness and direct healthcare costs of managing asthma in patients with evidence of persistent asthma, following the initiation and increased dose of inhaled corticosteroid (ICS) therapy using HFA-BDP (Qvar®) (either as initial therapy or as a step-up therapy) compared with the most commonly prescribed alternative ICS in the UK, CFC-beclometasone (BDP) and fluticasone (FP) as metered dose inhalers (MDIs). Qvar vs FP analyses were split between adults (12-60yrs) and paediatrics (5-11yrs).

Read the detailed description

While current UK asthma guidelines are underpinned with evidence from RCTs, much of this evidence has been undertaken in patients who are not representative of the majority of the current UK asthma population. In fact it has been estimated that fewer than 10% of the patients seen in everyday clinical practice would be eligible for inclusion in such trials. The poor representation of the asthma population is due to a number of factors, such as tightly-controlled inclusion criteria for RCTs. There is therefore a need for more representative RCTs and real-life and observational studies to inform existing guidelines and help optimise asthma outcomes. A more holistic approach to respiratory research would see RCT evidence complimented by "real-life" data from pragmatic trials and observational studies.

A number of trends are emerged in asthma prescribing that warrant further investigation to ascertain their benefit to both the patient and the NHS. In particular, significant pressure exists to use the cheapest inhaler devices and formulations. An analysis of a pragmatic trial of Qvar versus standard CFC-BDP undertaken by Research in Real Life suggested that Qvar may be offer greater effectiveness in.5,6 In light of these data, the following report details the findings of a study designed to examine the effectiveness of Qvar in real-life clinical practice using the General Practice Research Database (GPRD).

Conditions
Asthma
Being tested
Extra-fine hydrofluoroalkane-beclomethasone dipropionate, Fluticasone propionate, Beclomethasone dipropionate, Chlorofluorocarbon beclomethasone dipropionate
Keywords
Primary care, Asthma management, Inhaled corticosteroids, Beclomethasone dipropionate, Fluticasone propionate, Metred dose inhaler, Extra-fine hydrofluoroalkane, Chlorofluorocarbon
Medical subject headings
Asthma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Extra-fine hydrofluoroalkane-beclomethasone dipropionateDrug

    Also called Qvar®

    Initiation of HFA-BDP (any dose) in steroid naive patients via MDI

  • Extra-fine hydrofluoroalkane-beclomethasone dipropionateDrug

    Also called Qvar

    An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as HFA-BDP via MDI

  • Fluticasone propionateDrug

    An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as FP via MDI

  • Beclomethasone dipropionateDrug

    An increase in the baseline BDP-equivalent dose of inhaled corticosteroid as CFC-BDP via MDI

  • fluticasone propionateDrug

    Initiation of FP (any dose) via MDI in steroid naive patient

  • Chlorofluorocarbon beclomethasone dipropionateDrug

    Initiation of CFC-BDP (any dose) via MDI in steroid naive patient

Study groups in NCT01141439
Study groupRoleWhat they receive
IPDI HFA-BDP MDIPatients who commenced inhaled corticosteroid therapy as HFA-BDP via MDI
Receives: Drug: Extra-fine hydrofluoroalkane-beclomethasone dipropionate
IPDI FP MDIPatients who commenced inhaled corticosteroid therapy as FP via MDI
Receives: Drug: fluticasone propionate
IPDA FP MDIPatients who had a step up in inhaled corticosteroid therapy as FP via MDI
Receives: Drug: Fluticasone propionate
IPDA HFA-BDP MDIPatients who had a step up in inhaled corticosteroid therapy as HFA-BDP via MDI
Receives: Drug: Extra-fine hydrofluoroalkane-beclomethasone dipropionate
IPDI CFC-BDP MDIPatients who commenced inhaled corticosteroid therapy as CFC-BDP via MDI
Receives: Drug: Chlorofluorocarbon beclomethasone dipropionate
IPDA CFC-BDP MDIPatients who had a step up in inhaled corticosteroid therapy as CFC-BDP via MDI
Receives: Drug: Beclomethasone dipropionate

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proxy asthma control

    Primary composite measure asthma control defined as:

    • No recorded hospital attendance for asthma including admission, Accident \& Emergency (A\&E) attendance, out of hours attendance or Out-Patient Department (OPD) attendance, AND
    • No prescriptions for oral steroid, AND
    • No consultations, hospital admissions or A\&E attendance for lower respiratory tract infections (LRTI) requiring antibiotics.

    Measured: One-year outcome period

Secondary outcomes (6)
  1. Revised asthma control

    A revised definition of proxy asthma control for sensitivity analysis was defined as:

    • No recorded hospital attendance for asthma including admission, A\&E attendance, out of hours attendance or OPD attendance, AND
    • No prescriptions for oral steroid, AND
    • No consultations, hospital admissions or A\&E attendance for lower respiratory tract infections (LRTI) requiring antibiotics
    • Average daily prescribed dose of salbutamol of no more than 200mcg and terbutaline 500mcg.

    Measured: One-year outcome period

  2. Disaggregated components of the primary control outcome

    • Hospital admissions for asthma
    • Consultations and hospital attendances for LRTI requiring antibiotics
    • Prescriptions for oral steroids
    • SABA use

    Measured: One-year outcome period

  3. Time to the first asthma exacerbation

    Where an exacerbation is defined as:

    • An occurrence of unscheduled hospital admission/A\&E attendances for asthma AND/OR
    • Use of oral steroids.

    Measured: One-year outcome period

  4. Success of the therapeutic regimen

    Defined as:

    • Exacerbation AND/OR
    • Increase in dose of ICS AND/OR
    • Change in ICS drug type AND/OR
    • Change in delivery device AND/OR
    • Use of additional therapy as defined by: LABAs, oral steroids, theophylline, leukotriene receptor antagonists (LTRAs)

    Measured: One-year outcome period

  5. Use of anti-fungals

    defined as incidences of definite oral candidiasis

    Measured: One-year

  6. Daily dose of ICS (BDP equivalent) at week 52 compared with week 0 and proportion on original dose of BDP Daily dose* of ICS (BDP equivalent) at week 52 compared with week 0 and proportion on original dose of BDP.

    BDP-equivalent dose were calculated by multiplying the Qvar and FP doses by a factor of 2. The dose at week 52 was compared with that at week 0 in order to identify the proportion of original (week 0) ICS dose.

    Measured: One-year outcome period

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Jun 2010 (estimated)
  2. Study startJan 2001
  3. Primary completionJun 2007
  4. Study completionJul 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
815,377 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01141439
Sponsor's protocol ID
BA4
Acronym
QvarAsthma
Status last verified
Mar 2013
First submitted
9 Jun 2010
Last updated
14 Mar 2013
Results posted
No
Data monitoring committee
Yes

Publications

  • Herland K, Akselsen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger "real life" population of patients with obstructive lung disease? Respir Med. 2005 Jan;99(1):11-9. doi: 10.1016/j.rmed.2004.03.026.

    PubMed 15672843
  • Travers J, Marsh S, Caldwell B, Williams M, Aldington S, Weatherall M, Shirtcliffe P, Beasley R. External validity of randomized controlled trials in COPD. Respir Med. 2007 Jun;101(6):1313-20. doi: 10.1016/j.rmed.2006.10.011. Epub 2006 Nov 17.

    PubMed 17113277
  • Thomas M, Cleland J, Price D. Database studies in asthma pharmacoeconomics: uses, limitations and quality markers. Expert Opin Pharmacother. 2003 Mar;4(3):351-8. doi: 10.1517/14656566.4.3.351.

    PubMed 12614187
  • Tannen RL, Weiner MG, Xie D. Use of primary care electronic medical record database in drug efficacy research on cardiovascular outcomes: comparison of database and randomised controlled trial findings. BMJ. 2009 Jan 27;338:b81. doi: 10.1136/bmj.b81.

    PubMed 19174434
  • Juniper EF, Price DB, Stampone PA, Creemers JP, Mol SJ, Fireman P. Clinically important improvements in asthma-specific quality of life, but no difference in conventional clinical indexes in patients changed from conventional beclomethasone dipropionate to approximately half the dose of extrafine beclomethasone dipropionate. Chest. 2002 Jun;121(6):1824-32. doi: 10.1378/chest.121.6.1824.

    PubMed 12065345
  • Price D, Haughney J, Duerden M, Nicholls C, Moseley C. The cost effectiveness of chlorofluorocarbon-free beclomethasone dipropionate in the treatment of chronic asthma: a cost model based on a 1-year pragmatic, randomised clinical study. Pharmacoeconomics. 2002;20(10):653-64. doi: 10.2165/00019053-200220100-00002.

    PubMed 12162754
  • Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8.

    PubMed 3558716
  • Cliniclue [homepage on the internet]. The Clinical Information Consultancy CLINICLUE® [updated 2008; cited 15 May 2009]. Available online at: http://www.cliniclue.com

  • SPSS [homepage on the internet]. Chicago: SPSS Inc [updated 2009; cited 15 May 2009]. Available online at: http://www.spss.com/UK/

  • Microsoft office online [homepage on the internet]. USA: Microsoft Corporation [updated 2009; cited 15 May 2009]. Available online at: http://office.microsoft.com/excel

  • STATA: Data Analysis and Statistical Software [homepage on the internet]. Texas: STATA [updated 2009; cited 15 May 2009]. Available online at: http://www.stata.com/

Questions about this trial

What is this clinical trial studying?

An observational study of Asthma, run by Research in Real-Life Ltd at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Mar 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proxy asthma control (time frame: One-year outcome period). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01141439, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Mar 2013.

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QvarAsthma Clinical Trial NCT01141439 | AzTrials