A new paper has been published following on from discussions in the REG ILD working group meetings which aimed to identify opportunities for earlier diagnosis of idiopathic pulmonary fibrosis (IPF) that are being missed in primary care.

IPF is difficult to distinguish from other lung diseases with 50% of cases being misdiagnosed, leading to a highly negative impact on patients’ quality of life. Patients who receive a diagnosis of IPF in the UK will have first presented in the primary care setting.

A historical clinical cohort study was carried out by reviewing primary care records in the years preceding their diagnosis by examining continuous medical records of patients over 40 years of age in the UK who had been diagnosed with IPF over a ten-year study period. They found that there was a progressive increase in healthcare resource utilisation leading up their diagnosis and suggested that it might be possible to diagnose IPF by identifying potential opportunities for earlier referral to specialists.

https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13836

Following the round table discussion on the evolving algorithm of biological selection in severe asthma at the REG summit 2019, a new paper has been published, which summarises the reasoning for the use of different add-on medications for severe asthma and selection strategies.

Severe asthma patients, who don’t respond to regular treatments in a satisfactory matter, often require additional treatment. The choice of such interventions should reflect, if possible, the underlying endotype, which may have Type 2 or non-Type 2 immunity characteristics. Recently new treatment options have become available, mostly in the form of monoclonal antibodies (“biologicals”) that target inflammatory pathways.

This paper summarises the key characteristics of different options: non-biologic, anti-IgE, anti-IL5 and anti-IL5 receptor and anti-IL4/IL13 therapies. It presents a common sense, structured approach to disease evaluation, choice of medication and the monitoring/switching between treatments, focusing on simple principles resulting from available evidence and prioritising patient preferences in real life.

https://onlinelibrary.wiley.com/doi/full/10.1111/all.14256

The REG Adherence Working Group has recently published a paper in JACI in practice that investigates the relationship between ICS implementation and asthma-related outcomes, considering bidirectionality and temporal sequence.

Primary care records of 10,472 asthma patients from the Optimum Patient Care Research Database (www.opcrd.co.uk) were used. For each prescription interval (period between two successive prescriptions) in the 2-year outcome period ICS implementation (percentage of days covered) and Risk Domain Asthma Control (RDAC; no moderate or severe exacerbations) were estimated.

ICS implementation in the preceding prescription interval did not predict RDAC, but that ICS implementation was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without a COPD diagnosis and having <4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotic prescriptions and asthma-related outpatient visits in the same interval, and SABA overuse in the preceding and same interval predicted lower ICS implementation.

The lack of an association between ICS implementation and RDAC in consecutive intervals may suggest that patients may adapt their ICS use to meet their current needs without this impacting their later RDAC.

https://www.sciencedirect.com/science/article/abs/pii/S2213219819307809

Catch up with the latest REG news and happenings in our Winter 2020 Newsletter

REG, in collaboration with the European Academy of Allergy and Clinical Immunology (EAACI), have created a new tool (RELEVANT) to aid the appraisal of real life observational research. In April 2019, two papers detailing the methodology and use of RELEVANT were published in Clinical and Translational Allergy.

The RELEVANT tool was developed through literature review and synthesis and then iterative refinement of the tool. Multiple pilots were conducted, followed by validation using selected asthma research questions for which randomised controlled trials provided limited evidence.

The RELEVANT tool enables quality appraisal of published comparative effectiveness literature. RELEVANT has two tiers of criteria; primary criteria, all of which must be met to be considered suitable for use in guideline development; and secondary criteria, which allow further evaluation of the quality of a publication. The tool will therefore be useful for guideline developers, clinicians and researchers for assessing published literature or as a publication checklist. REG is proud to advance the acceptance of real life observational research in guideline development.

RELEVANT tool: https://www.regresearchnetwork.org/relevant-tool-2/

RELEVANT publications:

https://ctajournal.biomedcentral.com/articles/10.1186/s13601-019-0256-9

https://ctajournal.biomedcentral.com/articles/10.1186/s13601-019-0255-x

A great program attended by world leaders in respiratory research and medicine. Thank you to all participants and supporters. We look forward to seeing you at the REG Summit in 2020.

Catch up with the latest REG news and happenings in our Winter 2018 / 2019 Newsletter