Pharmacoepidemiology
Trends in Utilization of Chronic Asthma Medications among Publicly Insured Children in the US: 2003 – 2020 Celeste Ewig* Celeste Ewig Nicole Smolinski Almut Winterstein
Recent advances in our understanding of asthma treatments have led to additional considerations during clinical decision making. How these updates have affected utilization patterns of chronic asthma medications in pediatric patients with asthma remain uncharacterized. We aimed to describe the utilization of chronic asthma medications among publicly insured pediatric patients 2 to <18 years old with persistent asthma across relevant time periods of change.
We used Medicaid Analytic eXtract (MAX) and Transformed Medical Statistical Information System Analytic Files (TAF)national claims database. Individuals with persistent asthma defined as 1 hospital admission, or 3 outpatient visits with an asthma diagnosis identified from diagnosis codes, and a dispensing for a chronic asthma medication obtained from National Drug Codes, were identified within each calendar year The study period was divided into 3 periods: 2003 to 2008 (T1, FDA warnings for salmeterol in 2006 and montelukast in 2008), 2009 to 2014 (T2, post FDA warnings) and 2015 to 2020 (T3, post-approval of several biologic therapies). In each period, the proportion of pediatric patients with a dispensing of long-acting beta-agonists (LABA), montelukast, and asthma biologics was assessed using disproportionality analysis.
Our study included 1,953,516 pediatric patients (median age =6.7 years [IQR 4.3-10.2]). Males accounted for 59.9% of the population. The study population increased from 2003 to 2020 (T1=430,536, T2=591,941, and T3=820,179 individuals). Notable changes across time were observed in the proportion of the individuals using montelukast (T1=36.0% vs T3=33.1%, p<0.001), LABA (T1=2.5% vs T3 = 0.04%, p<0.001) and biologics (T1=0.1% vs T3=0.6%, p<0.001).
Although montelukast continues to be used by approximately a third of pediatric patients with persistent asthma, decline in utilization of LABA and increase in use of biologics appears to reflect advances in knowledge and uptake of newer therapies.