Treatment persistence with leukotriene receptor antagonists and inhaled corticosteroids.
BACKGROUND
Leukotriene receptor antagonists (LTRAs) and inhaled corticosteroids (ICSs) must be taken continuously to control persistent asthma. We compared the use of LTRAs and ICSs in patients with similar level of asthma control at treatment initiation with particular attention to treatment persistence.


METHODS
Two cohorts of 15 to 45 year old patients with asthma were selected from the Quebec Health Insurance Plan Database between January 1, 1998, and December 31, 2000. We first identified new users of LTRAs and from the remaining patients, we selected new users of ICSs. The ICS patients were then one-to-one matched to LTRA patients on the use of short-acting beta2-agonists and oral corticosteroids in the year prior to the date of the first LTRA or ICS dispensation (index date). We compared compliance to initial therapies using Cox proportional hazards models.


RESULTS
Each of the LTRA and ICS cohorts included 2200 patients. Multivariate model showed that compliance was significantly better for LTRAs than for ICSs [adjusted rate ratio of treatment discontinuation (aRR), 0.46; 95% confidence interval (CI), 0.42-0.49]. If in both groups all medications filled were taken at the prescribed dose, the annual percent of days on therapy for LTRA users would have been twice that for ICS users (38% vs. 19%; p<0.0001).


CONCLUSIONS
The findings of this observational study indicate a far from optimal persistence to LTRAs and ICSs in asthmatic patients. The superior persistence to LTRAs might result in better effectiveness.
Dorais
Marc
M
Research Group in Pharmacoepidemiology and Pharmacoeconomy, Research Center, Centre Hospitalier de l'Université de Montréal-Hôtel-Dieu (CHUM), Montréal, Québec, Canada.
Blais
Lucie
L
Chabot
Isabelle
I
LeLorier
Jacques
J
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D015331:Cohort Studies; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D010349:Patient Compliance
D000305:Adrenal Cortex Hormones; D020024:Leukotriene Antagonists