Long-Acting β2-Agonists or Leukotriene Receptor Antagonists as Add-On Therapy to Inhaled Corticosteroids for the Treatment of Persistent Asthma
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It is well accepted that the combination of inhaled corticosteroids (ICSs) and long-acting β2-agonists (LABAs) is effective in achieving asthma control, as it treats both components of asthma pathophysiology, namely inflammation and smooth muscle dysfunction of the airways. Leukotriene receptor antagonists (LTRAs) can also be used as add-ons to ICS therapy in patients whose asthma is not controlled by ICSs alone. The purpose of this review is to compare the effectiveness of ICSs plus LABAs with that of ICSs plus LTRAs for the treatment of persistent asthma that is not controlled by ICSs alone.
Several studies have shown that, in comparison with an ICS plus an LTRA, the addition of an LABA to ICS therapy provides greater improvements in pulmonary function and overall control of asthma as measured by use of rescue medication and the number of exacerbations of the asthma, symptom-free days and symptom-free nights. The greater improvements in pulmonary function observed with an ICS plus the LABA, salmeterol, occurred within the first week of treatment (at first treatment assessment), and remained significantly greater than those achieved with an ICS plus an LTRA over the duration of the treatment. Moreover, the salmeterol-fluticasone propionate combination (SFC) produces consistently greater improvements in pulmonary lung function and control of asthma than does the addition of an LTRA to fluticasone propionate. In addition, SFC is a more cost-effective treatment option than fluticasone propionate plus montelukast for patients with asthma that is uncontrolled by ICSs alone. Important cost savings can be made with SFC in clinical practice compared with other combinations of ICSs plus salmeterol or ICSs plus LTRAs.
- 3.Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Bethesda (MD): National Institutes of Health, National Heart, Lung, and Blood Institute; 2002. NIH Publication No. 02-3659Google Scholar
- 4.National Asthma Education and Prevention Program. Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Institutes of Health, National Heart, Lung, and Blood Institute; 1997. NIH Publication No. 97-4051Google Scholar
- 5.Pauwels RA, Lofdahl CG, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 1997; 337: 1405–11Google Scholar
- 9.Wilson AJ, Gibson PG, Coughlan J. Long acting beta-agonists versus theophylline for maintenance treatment of asthma. Cochrane Database Syst Rev 2000; (2): CD001281Google Scholar
- 12.Christian Virchow J, Prasse A, Naya I, et al. Zafirlukast improves asthma control in patients receiving high-dose inhaled corticosteroids. Am J Respir Crit Care Med 2000; 162 (2 Pt 1): 578–85Google Scholar
- 24.Pieters WR, Wilson KK, Smith HCE, et al. Cost-effectiveness of fluticasone propionate/salmeterol combination product and fluticasone propionate/montelukast in asthma [abstract]. Am J Respir Crit Care Med 2001; 163 (5 Pt 2): A643Google Scholar
- 25.Leibman AK, Stanford RH, Emmett A, et al. Cost-effectiveness of fluticasone propionate/salmeterol combination versus fluticasone + montelukast in the treatment of persistent asthma [poster C9]. The 98th International Conference of the American Thoracic Society; 2002 May 17–22; AtlantaGoogle Scholar
- 26.Booth PC, Capsey LJ, Langdon CG, et al. A comparison of the cost-effectiveness of alternative prophylactic therapies in the treatment of adult asthma. Br J Med Econ 1995; 8: 65–72Google Scholar
- 30.Ollendorf DA, Pozniak AS, Bowers BW, et al. Economic impact of salmeterol versus leukotriene modifiers in patients with chronic asthma. Chest 2000; 118: 185–6SGoogle Scholar
- 31.Gothard LR, O'Donnell JC, Johnson BA, et al. Cost consequences of dual controller therapy for asthma: inhaled corticosteroids used concurrently with either salmeterol or leukotriene modifiers. J Manag Care Pharm 2000; 6: 358–64Google Scholar