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. 2014 Sep-Oct;2(5):607-13.
doi: 10.1016/j.jaip.2014.05.009. Epub 2014 Jul 25.

Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids

Ann Chen Wu  1 , Lingling Li  2 , Vicki Fung  3 , Elyse O Kharbanda  4 , Emma K Larkin  5 , William M Vollmer  6 , Melissa G Butler  7 , Irina Miroshnik  2 , Donna Rusinak  2 , Robert L Davis  7 , Tina Hartert  5 , Scott T Weiss  8 , Tracy A Lieu  9
Affiliations

Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids

Ann Chen Wu et al. J Allergy Clin Immunol Pract. 2014 Sep-Oct.

Abstract

Background: Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS.

Objective: To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy.

Methods: This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use.

Results: Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS.

Conclusion: Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.

Keywords: Asthma; Controller medications; Effectiveness; Inhaled corticosteroids; Leukotriene antagonist; Long-acting β-agonist.

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Conflict of interest statement

Conflicts of interest: A. C. Wu, L. Li, D. Rusinak, R. Davis, and T. Lieu have received research support from the Agency for Healthcare Research and Quality (1R01HS019669). E. Kharbanda has received research and travel support from Agency for Healthcare Research and Quality (1R01HS019669). V. Fung and E. Larkin have received research support from the National Institutes of Health—AHRQ. W. Vollmer has received research support from Agency for Healthcare Research and Quality (1R01HS019669); and is employed by Kaiser Permanente. M. Butler has received research support from Agency for Healthcare Research and Quality (1R01HS019669) and Novartis. T. Hartert has received research and consulting fees from the National Institutes of Health; has received research support from Agency for Healthcare Research and Quality (1R01HS019669) and MedImmune; and is associate editor of the American Journal of Respiratory and Critical Care Medicine. S. Weiss has received consultancy fees from Novartis. I. Miroshnik declares that she has no relevant conflicts of interest.

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