ABS41: Montelukast as first-line preventative treatment for asthma in children age 2-5 yrs: A retrospective study

Abstract

Introduction:Inhaled corticosteroids (ICS) are the main treatment for persistent asthma in younger children in the UK. Montelukast is infrequently used as monotherapy.Aims:To evaluate asthma outcomes in children commenced on ICS or Montelukast as first maintenance treatment in routine practice utilizing the General Practice Research Database.Methods:Children aged 2–5 yrs. prescribed Montelukast or ICS as first maintenance asthma treatment having 12 months data before and after initiation were identified. Successful treatment was defined as: no hospital attendance, no oral corticosteroids, average daily dose of short acting B agonist (SABA) of under 1 dose/day over next 12 months.Results:Baseline data: no significant differences between Montelukast (n = 24) or ICC (n = 27041) cohorts in age, sex, rhinitis, respiratory hospitalisations, receipt of antibiotics for respiratory infections, courses of oral corticosteroids; montelukast cohort had fewer asthma consultations (Median, IQR) 0 (0–1) vs. 0 (0–1) p = 0.03, SABA devices prescribed, 0.5 (0–1) vs. 1.0 (0–2) p = 0.01. In the subsequent 12 months, the montelukast cohort were prescribed fewer SABA inhalers: 1, (0–2) vs. 2 (1–3) p > 0.001, fewer oral corticosteroid courses: (0 (0–0) vs. 0 (0–0), average 0.04 vs. 0.34, p = 0.03. No significant differences in asthma consultations, respiratory hospitalisations or antibiotics for respiratory infections. Successful treatment was observed for 58% of LTRA and 33% of ICS cohort (p = 0.01). Adjusted for baseline differences, odds ratio (95% CI) for success with LTRA was 2.4 (1.0–5.4) p = 0.04.Conclusions:In this ‘real-work’ database, limited experience with montelukast showed superior success to ICS therapy. Further research is required. Conflict of interest and funding None. Funding: An unrestricted grant from MSD.