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Leukotriene antagonists as first-line or add-on asthma-controller therapy
David Price1, Stanley D Musgrave, Lee Shepstone
1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom. david@rirl.org
The New England Journal of Medicine
|May 6, 2011
Summary
Leukotriene-receptor antagonists (LTRA) showed comparable effectiveness to inhaled glucocorticoids and long-acting beta(2)-agonists in real-world asthma management. These findings support LTRA as a viable treatment option for diverse primary care patients.
Area of Science:
- Pulmonology
- Real-world evidence in asthma management
- Comparative effectiveness research
Background:
- Asthma treatment trials often use highly selected patients under idealized conditions.
- Real-world effectiveness of common asthma medications needs further investigation.
- Pragmatic trials are essential for understanding treatment outcomes in diverse patient populations.
Purpose of the Study:
- To evaluate the real-world effectiveness of leukotriene-receptor antagonists (LTRA) compared to standard therapies for asthma.
- To assess LTRA as a first-line controller therapy versus inhaled glucocorticoids.
- To assess LTRA as add-on therapy versus long-acting beta(2)-agonists (LABA) in patients on inhaled glucocorticoids.
Main Methods:
- Conducted two parallel, multicenter, pragmatic trials over 2 years.
- Included primary care patients aged 12-80 with impaired quality of life or asthma control.
- Randomly assigned patients to open-label LTRA or inhaled glucocorticoid (first-line), or LTRA plus inhaled glucocorticoid or LABA plus inhaled glucocorticoid (add-on).
Main Results:
- Mean Mini Asthma Quality of Life Questionnaire (MiniAQLQ) scores improved in all groups.
- At 2 months, LTRA demonstrated equivalence to inhaled glucocorticoids and LABA.
- At 2 years, MiniAQLQ scores approached equivalence, with no significant differences in exacerbation rates or Asthma Control Questionnaire (ACQ) scores.
Conclusions:
- LTRA appears equivalent to inhaled glucocorticoids and LABA for diverse primary care asthma patients at 2 months.
- Equivalence was not definitively proven at the 2-year mark.
- Pragmatic trial limitations include patient crossover and lack of placebo groups, potentially affecting interpretation.
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