December 10, 2019
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Health care utilization, corticosteroid use higher in patients with asthma, allergic granulomatosis

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Mugdha Gokhale
Mugdha Gokhale

A need exists for treatments for specific eosinophilic granulomatosis with polyangiitis and medications to control symptoms and improve outcomes in patients with asthma, according to findings published in the Journal of Clinical Rheumatology.

“This is the first study to use large U.S. administrative claims data from millions of commercially insured individuals to quantify the burden of disease associated with eosinophilic granulomatosis with polyangiitis (EGPA), a rare, but debilitating disease,” Mugdha Gokhale, PhD, from the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, told Healio Pulmonology.

“EGPA patients in this study required frequent use of health care resources including all-cause and asthma-specific hospitalizations and emergency room visits, as well as high-dose chronic oral corticosteroids use, which is commonly known to be associated with adverse events. All of these point to an unmet treatment need in this population. Advances in specific treatment options are therefore important for management of this disease.”

A need exists for treatments for specific eosinophilic granulomatosis with polyangiitis and medications to control symptoms and improve outcomes in patients with asthma, according to findings published in the Journal of Clinical Rheumatology.
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To evaluate the prevalence and burden of EGPA and to assess health care utilization, the researchers enrolled two cohorts of patients aged 18 years and older from the Optum deidentified Clinformatics Datamart database between 2010 to 2014. The first cohort, EGPA 1, included 88 patients with two codes within 12 months of each other for eosinophilia and vasculitis or vasculitis and mononeuritis multiplex with a high positive predictive value. The second cohort, EGPA 2, included 604 patients with a lower positive predictive value and two codes within 12 months of each other for eosinophilia and vasculitis, vasculitis and mononeuritis multiplex or vasculitis and other neurologic symptoms.

Evaluated outcomes during the follow-up period included health care utilization and the use of EGPA maintenance medications. Asthma severity was measured 90 days before the index date. During the 12 months before the index date, or the baseline period, outcomes assessed included the frequency of asthma-related exacerbations such as hospitalizations or oral corticosteroid use and the presence of baseline comorbidities.

Findings showed that the annual prevalence of EGPA in the 4-year study varied depending on case definition, ranging from 3.2 to 5.9 cases per million in EGPA 1 vs. 23.4 to 30.7 cases per million in EGPA 2.

Results showed that approximately 30% of patients in each cohort had at least one hospitalization, with more asthma-related hospitalizations and fewer home health service visits occurring in EGPA 1 than EGPA 2.

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“The findings from this study demonstrate the high burden of this disease and the large use of health care resources required by EGPA patients in the U.S.,” Gokhale said. “This highlights the persistent symptoms experienced by these patients, like sinusitis, allergic rhinitis and asthma exacerbations, requiring medical attention and underscoring the need for EGPA-specific effective treatment strategies to improve symptom management and outcomes.”

In both cohorts, approximately 75% of patients were prescribed oral corticosteroids during the 1-year follow-up period with an average daily dose of at least 7.5 mg daily for the majority of patients in EGPA 1 and EGPA 2. Health care utilization generally increased with increasing daily dose of oral corticosteroids.

Despite the differences in prevalence, both cohorts showed similar rates of health care utilization. Higher oral corticosteroid use and the frequency of health care utilization in both cohorts highlight a potential need for EGPA-specific treatments and medications for patients with EGPA and asthma.

“Along with my fellow authors, I recognize the importance of this study to raise awareness of the burden of disease that patients and health care providers face when managing EGPA,” Gokhale said. “I hope that this study not only adds to the scientific evidence, but also helps inform decision-making about treatment and other disease management options available to these patients facing this rare disease.” – by Erin T. Welsh

Disclosures: Gokhale reports she holds stocks/shares and being an employee of GlaxoSmithKline. Please see the study for all other authors’ relevant financial disclosures.