Leukotriene antagonists as first-line or add-on asthma- controller therapy

January 01, 0001

Leukotriene antagonists as first-line or add-on asthma- controller therapy

These UK investigators conducted two parallel, multicenter, pragmatic trials to evaluate the real-world effectiveness of a leukotriene- receptor antagonist (LTRA) as compared with either an inhaled glucocorticoid for first-line asthma-controller therapy or a long-acting beta2-agonist (LABA) as add-on therapy in patients already receiving inhaled glucocorticoid therapy. Eligible primary care patients 12 to 80 years of age had impaired asthma-related quality of life (Mini Asthma Quality of Life Questionnaire {MiniAQLQ} score 6 or less) or inadequate asthma control (Asthma Control Questionnaire {ACQ} score 1 or more). They randomly assigned patients to 2 years of open-label therapy, under the care of their usual physician, with LTRA (148 patients) or an inhaled glucocorticoid (158 patients) in the first- line controller therapy trial and LTRA (170 patients) or LABA (182 patients) added to an inhaled glucocorticoid in the add-on therapy trial.

They found: "Mean MiniAQLQ scores increased by 0.8 to 1.0 point over a period of 2 years in both trials. At 2 months, differences in the MiniAQLQ scores between the two treatment groups met our definition of equivalence. At 2 years, mean MiniAQLQ scores approached equivalence, with an adjusted mean difference between treatment groups of -0.11 in the first-line controller therapy trial and of -0.11 in the add-on therapy trial. Exacerbation rates and ACQ scores did not differ significantly between the two groups."

The authors concluded: "Study results at 2 months suggest that LTRA was equivalent to an inhaled glucocorticoid as first-line controller therapy and to LABA as add-on therapy for diverse primary care patients. Equivalence was not proved at 2 years. The interpretation of results of pragmatic research may be limited by the crossover between treatment groups and lack of a placebo group."

Important because some patients strongly prefer oral controller therapy.

For the full abstract, click here.

N Engl J Med 364:1695-170, 5 May 2011
© 2011 to the Massachusetts Medical Society
Leukotriene Antagonists as First-Line or Add-on Asthma- Controller Therapy. David Price, Stanley D. Musgrave, Lee Shepstone, et al. Correspondence to Dr. Price: [email protected]

Category: R. Respiratory. Keywords: asthma, controller therapy, leukotriene receptor antagonist, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 13 May 2011

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