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Inhaled corticosteroids vs. leukotriene-receptor antagonists and asthma exacerbations in children
Lucie Blais1, Fatima-Zohra Kettani, Catherine Lemière
1Université de Montréal, Faculté de Pharmacie, C.P. 6128, Succursale Centre-ville, Montréal, Québec, Canada H3C 3J7. lucie.blais@umontreal.ca
Insights
Inhaled corticosteroids (ICS) may be less effective than leukotriene-receptor antagonists (LTRA) for childhood asthma exacerbations due to lower usage. LTRA showed better real-world effectiveness in reducing asthma attacks.
Area of Science:
- Pediatric Pulmonology
- Real-world Evidence in Asthma Management
- Pharmacotherapy Effectiveness
Background:
- Asthma exacerbations pose a significant burden on children.
- Inhaled corticosteroids (ICS) and leukotriene-receptor antagonists (LTRA) are common asthma controllers.
- Real-world effectiveness of ICS versus LTRA in pediatric asthma requires further investigation.
Purpose of the Study:
- To compare the effectiveness of ICS and LTRA monotherapy in reducing asthma exacerbations in children.
- To investigate the impact of medication adherence and usage patterns on treatment outcomes.
Main Methods:
- A retrospective cohort study of 27,355 asthmatic children (5-15 years) using Quebec administrative databases (1998-2005).
- Primary outcome: rate of moderate-to-severe asthma exacerbations (ED visits, hospitalizations, oral corticosteroid prescriptions) in the year following treatment initiation.
- Analyses stratified by prior exacerbation history; adherence measured by Proportion of Prescribed Days Covered (PPDC).
Main Results:
- Children on ICS had a significantly higher risk of exacerbations if they had no prior exacerbations (RR=2.3) compared to LTRA.
- No significant difference in exacerbation risk was observed for children with prior exacerbations (RR=1.6).
- LTRA group showed higher medication usage (52% days with supply) compared to ICS (34%), despite similar adherence (PPDC=66%).
Conclusions:
- LTRA may offer better real-world effectiveness in reducing pediatric asthma exacerbations compared to ICS.
- Lower utilization of ICS, potentially due to intermittent prescribing, may contribute to observed differences in effectiveness.
- Confounding by indication warrants consideration, but findings suggest potential advantages for LTRA in certain pediatric asthma populations.
Background:
Compared to inhaled corticosteroids (ICS), better use of leukotriene-receptor antagonists (LTRA) may lead to a greater reduction in exacerbations among asthmatic children in real-life settings.
Methods:
To test this hypothesis, we used the Quebec administrative databases and identified a cohort of 27,355 asthmatic children aged 5-15 years in whom ICS or LTRA monotherapy was initiated in 1998-2005. The primary outcome was the rate of moderate-or-severe asthma exacerbations (emergency department visit or hospitalization for asthma or a dispensed prescription of oral corticosteroids) over the subsequent year. The adjusted rate ratios (RR) of asthma exacerbations were estimated with Poisson regression models. To minimize confounding by indication, all analyses were stratified by the presence or not of an asthma exacerbation in the year before treatment initiation. We also measured the proportion of days with supply prescribed and patient's adherence with the Proportion of Prescribed Days Covered (PPDC).
Results:
The risk of exacerbations was significantly higher in the ICS than the LTRA group among children with no previous exacerbation (RR = 2.3; 95% CI:1.3-4.0), but not in those with ≥1 exacerbations (RR = 1.6; 0.8-3.1). The PPDC was similar between the groups (66%) but the proportion of days with supply prescribed was significantly higher in the LTRA than the ICS group (52% vs. 34%), resulting in higher use.
Conclusions:
While confounding by indication cannot be firmly ruled out, ICS appears to be more frequently prescribed as an intermittent than a daily controller therapy resulting in less use, which may contribute to the apparent lower effectiveness compared to LTRA.
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