Evaluation of Glucocorticoids Utilization in Central Kerala using Pharmacy Sales Overview

Safety and effectiveness of mepolizumab in adult patients with severe asthma with an eosinophilic phenotype from India: a Phase IV, open-label, single-arm, 24-week study (PRISM)

OBJECTIVE

Existing mepolizumab trials have excluded patients with severe asthma with an eosinophilic phenotype (SAEP) from India. This study (NCT04276233) investigated the safety and effectiveness of mepolizumab in Indian adults with SAEP.

METHODS

Multi-center, open-label, single-arm, interventional study; patients received 100 mg mepolizumab subcutaneously every four weeks for 24 weeks. Primary endpoint: incidence of adverse events (AEs), serious AEs (SAEs), and AEs of special interest (AESIs). Secondary endpoints: clinically significant exacerbation (CSEs) frequency (including exacerbations requiring hospitalization); change from baseline to Week 24 in forced expiratory volume/second (FEV1), peak expiratory flow (PEF), and Asthma Control Questionnaire (ACQ-5) scores.

RESULTS

Overall, 100 patients received ≥1 mepolizumab dose. Baseline characteristics: female, 51.0%; mean (standard deviation [SD]) age, 44.8 (12.0) years; mean (SD) body mass index, 24.4 (4.7) kg/m2. On-treatment AEs and SAEs were reported by 18.0% and 3.0% of patients, respectively; regarding AESIs, 5.0% reported infection and 2.0% reported systemic reaction. One fatal event occurred (unrelated to mepolizumab). CSEs were reported by 8.0% of patients; 2.0% had an exacerbation requiring hospitalization. Least squares (LS) mean change (95% confidence interval) in pre- and post-bronchodilator FEV1 and PEF by Week 24 was 0.081 L (-0.05, 0.21; p = 0.231), 0.055 L (-0.06, 0.17; p = 0.325), and 13.67 L/min (3.08, 24.25; p = 0.012), respectively. By Week 24, ACQ-5 scores had significantly improved (LS mean change [standard error]: -0.69 [0.121]; p < 0.001).

CONCLUSIONS

Mepolizumab was well tolerated in Indian adults with SAEP and improved asthma control and health-related quality of life.

Call to action: Addressing asthma diagnosis and treatment gaps in India

In comparison to the worldwide burden of asthma, although India contributes to 13% of the total asthma prevalence, it has a threefold higher mortality rate and more than twofold higher DALYs, indicating a substantial gap in asthma diagnosis and treatment. Asthma causes significant suffering, affecting people's quality of life and draining the country's resources; therefore, we must devise ways and means to fill these gaps. The most successful and cost-efficient strategy to battle asthma is to form strong partnerships between patients, the general public, the government, the pharmaceutical industry and non-governmental organisations. This necessitates a comprehensive approach that involves raising awareness, developing universally applicable recommendations, increasing access to high-quality asthma care, and other measures. The purpose of this article was to review the existing scenario of asthma management in India and the factors that contribute to it and devise unique and all-encompassing strategies to fill these gaps.

Trends and Patterns of Systemic Glucocorticoid Prescription in Primary Care Institutions in Southwest China, from 2018 to 2021

Purpose

The purpose of this study was to investigate the prescribing patterns and usage trends of systemic glucocorticoids in primary care institutions located in Southwest China from 2018 to 2021.

Materials and Methods

A retrospective cross-sectional analysis of systemic glucocorticoids prescriptions was conducted in 32 primary care institutions located in Southwest China between 2018 and 2021. Prescriptions of systemic glucocorticoids were classified as appropriate or inappropriate use. Inappropriate use was further classified into (1) inappropriate indications and (2) inappropriate selection of glucocorticoids. Generalized estimation equations were employed to investigate the factors associated with inappropriate utilization of systemic glucocorticoids. The seasonal autoregressive integrated moving average (SARIMA) model was employed to predict the rate of inappropriate glucocorticoids prescriptions.

Results

A total of 203,846 (92.89%) prescriptions were included, both the number of systemic glucocorticoids prescriptions and inappropriate prescriptions increased in winter. Diseases of the respiratory system (68.90%) were the most frequent targets of systemic glucocorticoids use. Of all prescriptions, 73.18% exhibited inappropriate indications, while 0.05% demonstrated inappropriate selection. The utilization of systemic glucocorticoids was deemed inappropriate for diseases of the respiratory system (94.19%), followed by diseases of the digestive system (87.75%). Physicians, who were female or younger than 33 years old, possess lower levels of education and professional titles and exhibit a higher likelihood of inappropriately prescribing systemic glucocorticoids. The phenomenon of inappropriate glucocorticoids use was commoner among male patients aged 65 years and older. After conducting model verification, it was determined that the SARIMA model could be used to predict the monthly rate of inappropriate systemic glucocorticoids prescriptions in primary care institutions in southwest China.

Conclusion

The inappropriate use of systemic glucocorticoids remains a significant concern in primary care institutions. In this regard, continuing education and professional knowledge training of physicians should be strengthened in the future.