Effectiveness of combination therapies in asthma: an observational study.
BACKGROUND
Asthma guidelines suggest that a long-acting beta-agonist be added to the treatment regimen of patients not adequately controlled on a low to moderate dose of inhaled corticosteroids. We compared the effectiveness in a real world setting of two such combinations available in a single inhaler.


METHODS
We identified patients initiating therapy with either budesonide/formoterol or fluticasone/salmeterol after May 2001 in a clinical database. We compared asthma medication and health care utilisation over the subsequent year.


RESULTS
There were 6918 first-time users of budesonide/formoterol and 16,157 of fluticasone/salmeterol. Overall, there were no differences between the two treatment groups in hospitalisations for asthma (23 and 25 per 1000 per year) or visits to the physician during follow-up. Duration of treatment success defined as the time to occurrence of an exacerbation or the need for different or additional anti-inflammatory therapy was also similar in both groups at approximately 8.6 months. The mean duration of persistent treatment was 13% longer with budesonide/formoterol (95% CI 11-16%), during which budesonide/formoterol subjects received 11% less prescriptions for their combination therapy (95% CI 9-13%). Fluticasone/salmeterol users were less likely to require referral to a specialist.


CONCLUSIONS
We found similar effectiveness for the budesonide/formoterol and fluticasone/salmeterol combinations. Such equivalence appears to be obtained at lower relative doses of inhaled corticosteroids with the budesonide/formoterol combination.
Suissa
Samy
S
McGill Pharmacoepidemiology Research Unit, McGill University Health Centre, Montreal, Canada.
Dell'Aniello
Sophie
S
Ernst
Pierre
P
D000328:Adult; D000420:Albuterol / Q000031:analogs & derivatives / Q000627:therapeutic use; D000730:Androstadienes / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use; D005260:Female; D000068298:Fluticasone; D000068759:Formoterol Fumarate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000068299:Salmeterol Xinafoate; D016896:Treatment Outcome
D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D004338:Drug Combinations; D004983:Ethanolamines; D019819:Budesonide; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol; D000068759:Formoterol Fumarate