Observational study of the effects of using montelukast vs fluticasone in patients matched at baseline.
BACKGROUND
The relative effectiveness of inhaled corticosteroids and leukotriene receptor antagonists in asthma therapy continues to be the subject of clinical studies. Recent studies have examined the impact of these therapies using a retrospective design. Retrospective studies require special attention to nonrandom assignment of participants to treatment groups and, consequently, to the need to appropriately account for baseline differences.


OBJECTIVE
To examine the relative effectiveness of montelukast sodium vs fluticasone propionate as controller monotherapy in patients with asthma.


METHODS
A retrospective cohort analysis of claims data from 6,160 individuals continuously enrolled in 1 of 20 US managed care plans. Patients using fluticasone were matched to those treated with montelukast using propensity scores and age (2-55 years). Health care use was determined for the 12-month periods before and after the initial controller prescription. Outcomes included asthma-related hospitalizations and emergency department visits, along with use of oral corticosteroids and short-acting beta-agonists. Logistic regression analyses were also performed.


RESULTS
Overall, controller therapy significantly reduced the odds of postindex asthma-related hospitalizations (odds ratio, 0.56; 95% confidence interval, 0.38-0.79); no significant difference was observed with asthma-related emergency department visits (odds ratio, 0.89; 95% confidence interval, 0.76-1.04). Differences in the relative effect in the montelukast and fluticasone groups were not observed. Similarly, increases in the postindex rate of short-acting beta-agonist use and increases in oral corticosteroid use for both montelukast and fluticasone patients were noted.


CONCLUSIONS
Similar outcomes were observed in montelukast and fluticasone users in this matched cohort analysis.
Allen-Ramey
Felicia C
FC
Merck & Co Inc, West Point, Pennsylvania 19486-0004, USA. felicia_ramey@merck.com
Duong
Phong T
PT
Riedel
Aylin A
AA
Markson
Leona E
LE
Weiss
Kevin B
KB
D000085:Acetates / Q000627:therapeutic use*; D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000730:Androstadienes / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003521:Cyclopropanes; D005260:Female; D000068298:Fluticasone; D006760:Hospitalization; D006801:Humans; D007345:Insurance Claim Review; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011804:Quinolines / Q000627:therapeutic use*; D012189:Retrospective Studies; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast