Files and links (1)
Published, Version of Record (VoR)Open Access via Drexel Libraries Read and Publish Program 2024CC BY-NC-ND V4.0, Open
Journal article
Modification of asthma treatment efficacy by healthcare access: A reanalysis of AsthmaNet Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) clinical trial
Respiratory medicine, v 234, 107853
05 Nov 2024
Featured in Collection : Research Supported by Drexel Libraries' OA Programs
Abstract
While randomized controlled trials (RCTs) in asthma management are designed to balance known and unknown variables across treatment groups, including social and environmental co-exposures, it remains important to consider how these co-exposures influence disease progression and treatment outcomes. The importance of considering socio-environmental co-exposures in the context of asthma is twofold: 1) asthma disproportionately affects low-income urban communities, where air pollution and chronic stress are pervasive; and 2) despite the wide range of asthma treatments, inadequate disease control persists.
In the present ancillary study of the Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) RCT, we investigated how socio-environmental factors, such as air pollution exposure and healthcare access, modify the effect of inhaled corticosteroid (ICS) therapy in children with asthma. The original STICS RCT evaluated the efficacy and safety of increasing the dose of inhaled glucocorticoids from a baseline daily low dose to five times the daily dose for 7 days in school-age children with mild-to-moderate persistent asthma who began to have short-term loss of asthma control (1). Our study adds onto those findings by incorporating residential level particulate matter 2.5 μg/m3 (PM2.5) and geographic health provider shortage areas (HPSA) as potential modifiers.
Consistent with the main trial results, we did not find a difference in the number of exacerbations between treatment arms. However, we found the effect of receiving 5xICS, as compared with 1xICS on the time to prednisone was significantly different for children living in areas a shortage of health professionals (HR: 2.09; 95% CI: 0.74, 5.95) than for children living in no shortage areas (HR: 0.40; 95% CI: 0.21, 0.77).
This finding underscores the importance of considering environmental and social factors in asthma treatment
ClinicalTrials.gov ID NCT02066129 https://clinicaltrials.gov/study/NCT02066129.
• Highlights STICS
• Socioenvironmental factors are key to understanding asthma treatment across populations
• healthcare access can influence the effectiveness of asthma treatments
• Higher ICS doses help asthma in well-resourced areas, not in care-deficient ones
Metrics
21 Record Views
Details
- Title
- Modification of asthma treatment efficacy by healthcare access: A reanalysis of AsthmaNet Step-Up Yellow Zone Inhaled Corticosteroids to Prevent Exacerbations (STICS) clinical trial
- Creators
- Lizbeth F. Gómez (Corresponding Author) - Drexel University, Environmental and Occupational HealthEllen Kinnee - Drexel University, Environmental and Occupational HealthJoel D. Kaufman - University of WashingtonMichael T. Young - University of WashingtonAnne M. Fitzpatrick - Emory University Department of PediatricsWanda Phipatanakul - College Station Medical CenterDavid T. Mauger - BiostatLeslie A. McClure - Drexel University, Epidemiology and BiostatisticsUsama Bilal - Drexel University, Epidemiology and BiostatisticsFernando Holguin - UPMC MontefioreJane E. Clougherty - Drexel University, Urban Health Collaborative
- Publication Details
- Respiratory medicine, v 234, 107853
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- NIH National Heart, Lung, and Blood Institute (NHLBI): 1R01HL114536-01 NIH: HL098302, HL098096, HL098075, HL098090, HL098177, HL098098, HL098107, HL098112, 098,103, HL098115
This work was funded by the NIH National Heart, Lung, and Blood Institute (NHLBI) (1R01HL114536-01: Validating GIS-based methods to address spatial uncertainty in clinical trials, to JEC and FH) . The Asth-maNet trials were funded by NIH grants HL098302, HL098096, HL098075, HL098090, HL098177, HL098098, HL098107, HL098112, 098,103, and HL098115.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Epidemiology and Biostatistics; Environmental and Occupational Health
- Web of Science ID
- WOS:001355943000001
- Scopus ID
- 2-s2.0-85208350769
- Other Identifier
- 991021934315504721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System