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Adverse drug reactions affecting treatment adherence in first-line treatment of asthma: An observational study
Semiha Bahceci Erdem1, Hikmet Tekin Nacaroglu2, Demet Can3
1Izmir Bakırçay University, Çiğli Training and Research Hospital Pediatric Immunology and Allergy, Izmir, Turkey.
Insights
Children with asthma discontinuing montelukast due to adverse drug reactions (ADRs) occurred more frequently than with inhaled corticosteroids (ICS). This impacts treatment adherence in pediatric asthma management.
Area of Science:
- Pediatric Pulmonology
- Pharmacovigilance
- Allergy & Immunology
Background:
- Asthma is a leading chronic respiratory condition in children, necessitating effective management strategies.
- International guidelines prioritize inhaled corticosteroids (ICS) as first-line therapy, with leukotriene receptor antagonists (LTRA) as an alternative.
- Optimizing treatment benefits hinges on patient adherence, which can be compromised by adverse drug reactions (ADRs).
Purpose of the Study:
- To assess the incidence of drug discontinuation resulting from ADRs in pediatric patients with asthma or asthma and allergic rhinitis.
- To compare discontinuation rates between monotherapy with LTRA (montelukast) and ICS.
Main Methods:
- The study included 468 children aged 4-18 years using either montelukast or ICS monotherapy.
- Participants were evaluated for ADRs impacting treatment adherence at one and three months.
- Data on drug discontinuation due to ADRs were collected and analyzed.
Main Results:
- Montelukast monotherapy was used by 356 children, while 112 received ICS.
- In the first month, 4.8% of montelukast recipients discontinued treatment due to ADRs.
- The drug discontinuation rate due to ADRs was significantly higher in the montelukast group compared to the ICS group (P=0.016), with a 1.333 times greater risk.
Conclusions:
- Children with asthma on montelukast monotherapy experienced higher rates of discontinuation due to ADRs than those on ICS monotherapy.
- ADRs significantly impact treatment adherence in pediatric asthma patients.
- These findings underscore the importance of monitoring for ADRs to ensure effective asthma management in children.
Background:
Asthma is the most common chronic lung disease among children. International guidelines recommend inhaled corticosteroids (ICS) as the first-line daily controller therapy for children with asthma and leukotriene receptor antagonists (LTRA) as the second alternative therapy. Adherence to treatment is the most significant component to optimize the benefits of therapy in asthma.
Objective:
This study aims to investigate the frequency of drug discontinuation due to adverse drug reactions (ADRs) that affect adherence to treatment in children with asthma or asthma and allergic rhinitis using LTRA or ICS as monotherapy.
Methods:
The subjects aged 4-18 years with asthma or asthma and allergic rhinitis and using montelukast or ICS as monotherapy were included in the study. They were evaluated in terms of ADRs affecting adherence to treatment in the first and third months of treatment.
Results:
A total of 468 cases, 356 of whom received montelukast monotherapy and 112 of whom received ICS treatment, with a mean age of 9.10 ± 3.08 (4-17) years, were included in the study. Males constituted 65.6% of the total cases (n = 307). In the first month of follow-up of the cases, it was observed that 4.8% (n = 17) of the patients in the montelukast group could not continue the treatment due to ADR. It was determined that the drug discontinuation rate in the montelukast group in the first month was significantly higher than in the ICS group (P = 0.016), and the risk of drug discontinuation due to ADR in the montelukast group was 1.333 (95% CI, 1.26-1.40) times higher.
Conclusions:
As a result, it was observed that the drug was discontinued due to ADR at a higher rate in children with asthma who received montelukast monotherapy compared to those who received ICS monotherapy.
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