Corticosteroids inhaled once daily give better drug adherence in children with asthma: Study

Canada: Inhaled corticosteroids (ICS) dose once a day is related to higher drug adherence than dosing twice a day, says an article published in Annals of Allergy, Asthma & Immunology. Poor asthma control is linked to poor adherence to inhaled corticosteroids. Adult studies show that simplifying the ICS protocol improves adherence. As a result, Olivier Drouin and colleagues wanted to see if once-daily ICS administration was related to greater adherence among asthmatic children than twice-daily dosing.

Between 2011 and 2019, a retrospective observational study of children with asthma who were administered either once-daily or twice-daily ICS monotherapy was done. The proportion of prescribed days covered (PPDC), or the number of days for which the drug was dispensed by the pharmacy divided by the number of days for which it was prescribed, was the primary adherence result. The effect of a once-daily ICS regimen versus a twice-daily ICS regimen on adherence was investigated using linear multivariable regression analysis with variables adjusted. The proportion of patients with an adherence rate of at least 75% was examined using logistic regression models as a secondary outcome.

The key findings of this study were as follow:

1. A total of 232 children (61% males; mean age of 5.8 (3.6) years) were involved, with 120 receiving once-daily ICS and 112 receiving twice-daily ICS.

2. The once-daily group had a median PPDC of 66.8%, while the twice-daily group had a median PPDC of 57.9%.

3. When compared to the twice-daily group, children on once-daily ICS had a 7.2% higher mean PPDC and a higher chance of having PPDC 75 percent (71.4% vs 45.5%).

In conclusion, Adequately powered trials are needed to confirm if improved adherence to a once-daily dosage regimen leads to a significant improvement in asthma control and time to exacerbation.

Reference: 

Drouin O, Smyrnova A, Betinjane N, Ducharme FM. Adherence to inhaled corticosteroids prescribed once- vs twice-daily in children with asthma. Ann Allergy Asthma Immunol. 2022 Jan 22:S1081-1206(22)00022-9. doi:10.1016/j.anai.2022.01.018. Epub ahead of print. PMID: 35077865