Clinical and economic outcomes associated with low-dose fluticasone propionate versus montelukast in children with asthma aged 4 to 11 years.

Richard H Stanford,Manan Shah,Sham L Chaudhari

doi:10.2174/1874306401206010037

Abstract

Objective:Inhaled corticosteroids (ICS) are preferred first-line controller agents for adults and adolescents with asthma. There is limited effectiveness data comparing ICS to leukotriene receptor antagonists (LTRA) in children with asthma aged 4 to 11 years.Methods:A retrospective, matched cohort study was conducted using medical and pharmacy claims data. Asthma patients (ICD-9, 493.xx) naïve to any asthma controller therapy, and having ≥1 dispensing of fluticasone propionate 44 mcg (FP44), an ICS, or montelukast any dose (MON), an LTRA, were identified. Drug cohorts were matched (1:2) using propensity scores. Outcomes during follow-up included asthma-related ED visits, composite measure of asthma-related ED/hospital visit, asthma-related costs per month, and monthly rescue medication use. Statistical differences between cohorts were evaluated using multivariate regression models.Results:The final matched sample included 6,636 patients (FP44=2,212; MON=4,424). During follow-up, the FP44 cohort had a 29% significantly lower risk of an asthma-related ED visit (Hazard ratio (95% CI) =0.71 (0.52, 0.96)) compared to the MON cohort. Monthly asthma-related costs were significantly reduced on average by 36% in the FP44 compared to the MON cohort ($48 vs $75, p<0.05). Use of short-acting beta-agonists per month were similar between cohorts but monthly adjusted number of oral corticosteroid prescriptions were significantly lower in the FP44 compared to the MON cohort (0.03 vs 0.04, p<0.001).Conclusion:Initiation of FP44 versus MON in children with asthma aged 4 to 11 years is associated with a significant reduction in asthma-related ED visits, costs, and oral corticosteroid use.

Highlights

Asthma exerts a significant morbid toll on children as rates of asthma attacks leading to emergency department visits and hospitalizations are more than twice in children under 18 years of age compared to adults [1]
Asthma is the second-ranking cause of all hospitalizations in children accounting for 7% of all stays for pediatric illnesses [2]
Inhaled corticosteroids (ICS) were observed to have better clinical efficacy when compared to leukotriene receptor antagonists (LTRA) for the treatment of mild persistent asthma based on a Cochrane Review [15]

Summary

Introduction

In comparison with no ICS treatment, treatment with ICS in children has been shown to improve pulmonary function, and decrease asthma exacerbations leading to hospitalizations and emergency department (ED) visits [5,6,7]. In head-to-head comparative, randomized controlled trials in children > 2 years of age with other long-term controller therapy options such as LTRAs, ICSs have been shown to have superior efficacy [8,9,10,11,12,13,14]. In the most recent of these studies, fluticasone propionate (FP), an ICS was compared to an LTRA, montelukast (MON) in children with asthma aged 4-17 years who were previously receiving ICS therapy [17]. Significant economic benefits in terms of reduced asthma-related costs were found for FP compared to the MON cohort [19]

Methods

Results

Conclusion