ABS006: Montelukast add-on therapy compared to high-dose inhaled corticosteroids in children age 2-5 yrs with asthma: a retrospective study

Abstract

For children aged 2–5 with asthma uncontrolled on standard doses of inhaled corticosteroids (ICS), options include addition of montelukast or higher-dose ICS. To compare outcomes in children stepping up to either treatment, utilizing the General Practice Research Database. Asthmatic children aged 2–5 yrs. treated by ICS (200 mcg/day beclomethasone equivalent or less) whose first treatment increase was addition of montelukast or increased-dose ICS, having 12 months data before and after step-up were identified. Successful treatment was defined as: no recorded hospital attendance, no oral corticosteroids, average use of short acting B agonist (SABA) of under 1dose/day over 1 year. Montelukast (n = 127) and ICS (n = 3596) cohorts were similar in age and sex, and prior to step-up had similar asthma consultations, respiratory hospitalisations, antibiotics use for respiratory infections; montelukast cohort used more SABA devices, median (IQR) 3 (2–5) vs. 2 (1–4) p > 0.000, and more oral steroid courses, 0 (0–0) vs. 0 (0–0), average 0.68 v 0.52, p = 0.019, and a lower proportion had rhinitis (5% vs. 13%, p = 0.004). In the 12 month outcome period, the montelukast cohort showed non significant trends to fewer SABA devices: 2 (1–4) vs. 3 (1–4) p = 0.203 and oral steroid courses: 0 (0–0) vs. 0 (0–1), average 0.39 vs. 0.44, p = 0.431. No significant differencesvin asthma consultations, respiratory hospitalisation or use of antibiotics. Successful treatment was observed for 33% of LTRA and 25% of ICS cohort (p = 0.052). Adjusted for baseline differences, the odds ratio (95% CI) for success with LTRA compared to ICS was 1.9 (1.3–2.8) p = 0.002. In this ‘real-work’ database, patients stepped up by montelukast addition had an almost doubled chance of successful treatment over those increasing ICS dose. Conflict of interest and funding No conflict of interest declared. Funding: MSD UK.