Comprehensive Evaluation Of Medication For Moderate To Severe Bronchial Asthma

Objective:Bronchial asthma is a global public health problem,and patients need to adhere to long-term treatment under the guidance of a doctor to achieve the overall goal of controlling disease symptoms and reducing future risks.Multi-drug combination is a common treatment for moderate and severe bronchial asthma,but the combination of drugs has increased the potential risk of adverse reactions,and also brought a serious economic burden to patients.This study compared the efficacy and safety of different combination regimens,and evaluated the pharmacoeconomic indicators of each regimen,providing a reference for the choice of medication for the treatment of moderate to severe bronchial asthma.At the same time,meta-analysis was used to analyze the existing clinical studies of omalizumab and mepolizumab in the treatment of moderate and severe bronchial asthma It is hoped that reliable evidence-based medical evidence for the clinical efficacy and safety of new drug monoclonal antibodies in the treatment of bronchial asthma will provide a basis for assisting the rational use of monoclonal antibody drugs in the futureMethods:In this study,312 patients with moderate to severe bronchial asthma in the Northeast China from January 2017 to January 2018 were selected from the First Hospital of China Medical University in Shenyang,Liaoning Province,according to the patient's age and control medication.The children's components are ICS+LTRA group,ICS+LTRA+LABA group,2 subgroups;adult components are ICS+LABA group,ICS+LABA+LTRA group,ICS+LABA+LAMA group,ICS+LABA+LTRA+LAMA group,a total of 4 subgroups.The ACT scores at the time of discharge from the hospital,3 months after discharge,and 6 months after discharge were used as the main efficacy indicators.The patient's FEVi%at discharge was used as a secondary indicator At the same time,the patient's heart rate and blood pressure were evaluated as safety indicators The pharmacoeconomic study used the cost-effectiveness analysis to compare the cost-effectiveness ratios of patients with different treatment regimens from hospitalization to follow-up of 3 months.Finally,by comparing the efficacy,safety and economy of different treatment options,the best choices are selected for good efficacy,high safety and low cost In the meta-analysis,all randomized controlled trials of omalizumab and mepolizumab in the treatment of bronchial asthma were collected by computer retrieval of databases such as CNKI,VIP,WANFANG,PubMed,Embase,Cochrane Library,and Web of Science.The two researchers screened the retrieved documents based on inclusion and exclusion criteria,and then performed data extraction and article quality evaluation.Meta-analysis was performed using RevMan5.3 software.Results:1.The ACT(or C-ACT)score in the ICS+LTRA+LABA treatment group was superior to the ICS+LTRA treatment group at 3 months after discharge and 6 months after discharge(p<0.05).The FEVi%of the two groups increased by 12.4%and 24.1%,respectively,and the ICS+LTRA+LABA group was significantly superior in FEVi%improvement(p=0.044).Two treatment regimens did not report serious adverse events associated with medication during treatment.The cost-effectiveness ratio for the ICS+LTRA group was 90.93,and that for the ICS+LTRA+LABA treatment group was 88.10.The ICS+LTRA+LABA program has an economic advantage.2.There was no significant difference in ACT scores between the four treatment regimens in adult patients during the same period(p>0.05).After treatment,the FEV1%of the four groups increased compared with that before treatment,among which ICS+LABA group increased by 22.3%,ICS+LABA+LTRA group increased by 23.0%,ICS+LABA+LAMA group increased by 33.1%,ICS+LABA+LTRA+LAMA group increased by 34.8%.Four treatment regimens did not report serious adverse events associated with medication during treatment.The cost-effectiveness ratios of the four groups were 130.42,129.08,156.59 and 150.40,respectively.The comparison of pharmacoeconomic advantages is:ICS+LABA+LTRA>ICS+LABA>ICS+LABA+LTRA+LAMA>ICS+LABA+LAMA.3.Meta-analysis showed that the risk of acute asthma attack was reduced by 31%in the omalizumab-treated group[RR=0.69,95%CI(0.62,0.76),p<0.0001],and the mepolizumab group was reduced by 17%[RR=0.83,95%CI(0.71,0.96),p=0.01],the difference was statistically significant(p=0.001).The monoclonal antibody group was superior to the control group in terms of improvement in FEV1[MD=0.09,95%CI(0.06,0.12),p<0.00001],improvement in ACQ[MD=-0.32,95%CI(-0.45,-0.20),p<0.00001],and improvement in AQLQ[MD=0.25,95%CI(0.12,0.37),p<0.0001].After using monoclonal antibodies,the risk of serious adverse reactions was reduced by 30%[RR=0.70,95%CI(0.58,0.83),p<0.0001].Mepolizumab significantly reduced blood eosinophil levels in asthmatic patients[MD=-0.27,95%CI(-0.37,-0.17),p<0.00001].Conclusion:1.For children,a combination of inhaled corticosteroids,long-acting beta2-agonists and leukotriene receptor antagonists have a good clinical efficacy,drug safety and economy.It is the best choice for long-term control of children with moderate to severe asthma.2.For adult patients,when it is necessary to superimpose different mechanisms of action for treatment,the efficacy has an increasing trend with the increase of combination drugs.In combination with inhaled corticosteroids,long-acting beta2-agonists and leukotriene receptor antagonists in different treatment regimens,it has shown a better pharmacoeconomic advantage.3.Patients receiving omalizumab or mepolizumab were significantly better than non-users in reducing asthma exacerbation,improving lung function,reducing the incidence of serious adverse reactions,and improving quality of life Among them,omalizumab is better than mepolizumab in reducing the risk of asthma exacerbation.At the same time,mepolizumab significantly reduced blood eosinophil levels in patients with bronchial asthma.