title: Patient characteristics and prescription fill patterns for allergic rhinitis medications, with a focus on montelukast, in a commercially insured population.
abstract: BACKGROUND
  Allergic rhinitis (AR), also known as hay fever, is caused by an overreaction of the immune system to airborne allergens. AR is a substantial cause of widespread morbidity, medical treatment costs, and reduced productivity at work and school.
  
  
  OBJECTIVE
  The goal of this research was to describe patient characteristics and prescription fill patterns for patients with AR and to determine those factors associated with the use of montelukast in a large population of commercially insured patients who sought medical treatment for AR.
  
  
  METHODS
  This was a retrospective cohort study using administrative claims data from a commercially available database. Patients, aged 4 to 64 years, with >or=3 years' continuous enrollment and >or=1 medical claim for AR between January 1, 2004, and December 31, 2006, were included. Patients with a concomitant asthma diagnosis were excluded. Patients' demographic and clinical characteristics, comorbidities, health care resource utilization, AR-related medication use, and AR-related physician office visits were assessed for 12 months before the first AR medication fill (index) in 2006. Stepwise logistic regression was used to identify factors predicting the initiation of montelukast therapy for the treatment of AR in 2006.
  
  
  RESULTS
  The study population consisted of 75,140 children (mean [SD] age, 10.6 [4.0] years) and 226,236 adults (mean age, 43.8 [11.8] years). Slightly more than half (52.4%) of the pediatric population was male compared with 44.7% of the adult population. Fifty percent of patients had no pharmacy fills for an AR medication in 2006. Among patients with AR pharmacy fills (n = 150,751), 78.1% had a single index medication fill (montelukast represented 4.5%) and 21.9% were prescribed multiple index medications. Children with AR were more likely to fill a prescription for montelukast (n = 7513) if they were 4 to 11 years of age; male; diagnosed with cough/wheeze; and had 1 or 2 oral corticosteroid fills, >or=3 antibiotic fills, and AR-related physician office visits in the prior 12 months (all, P < 0.001). Prescription fills for montelukast among adult patients with AR were significantly (P < 0.001) associated with other respiratory/atopic conditions; prior fills for antihistamines, oral corticosteroids, or intranasal corticosteroids; and AR-related physician office visits in the prior 12 months. Children and adults with health plans based in the midwestern or southern region of the United States had greater odds of initiating montelukast than those with plans based in the western region (P < 0.001).
  
  
  CONCLUSIONS
  Half of the patients identified with AR did not fill a prescription for an AR medication. Among those patients with AR-related prescription drug fills, most were prescribed a single index pharmacotherapy and did not receive additional AR medications within 30 days of the index date. The use of montelukast was limited and was more commonly prescribed to children and adults with AR whose condition was not controlled with other AR medications.
authors.affiliation: Division of Pediatric Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mbolling@peds.umaryland.edu
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Bollinger
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Chun-Lan
authors.initials: CL
authors.lastname: Chang
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: Shiva G
authors.initials: SG
authors.lastname: Sajjan
authors.forename: Tao
authors.initials: T
authors.lastname: Fan
authors.forename: Felicia C
authors.initials: FC
authors.lastname: Allen-Ramey
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003521:Cyclopropanes; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy*; D012737:Sex Factors; D013440:Sulfides; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000085:Acetates; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; C093875:montelukast