title: Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.
abstract: BACKGROUND
  Based on results of clinical trials, inhaled corticosteroids (ICS) are the most-effective controller medications for preventing asthma-related exacerbations, yet few studies in real-life populations have evaluated the comparative effectiveness of ICS.
  
  
  OBJECTIVE
  To determine the likelihood of asthma exacerbations among children with asthma after initiation of controller medications: ICS, leukotriene antagonists (LTRA), and ICS-long-acting β-agonist (LABA) combination therapy.
  
  
  METHODS
  This was a retrospective cohort study of subjects who were part of the Population-Based Effectiveness in Asthma and Lung Diseases Network. We conducted Cox regression analyses by adjusting for baseline covariates, adherence by using proportion of days covered, and high-dimensional propensity scores. The main outcome measurements were emergency department visits, hospitalizations, or oral corticosteroid use.
  
  
  RESULTS
  Our population included 15,567 health plan subjects and 10,624 TennCare Medicaid subjects with uncontrolled asthma. Overall adherence to controller medications was low, with no more than 50% of the subjects refilling the medication after the initial fill. For subjects with allergic rhinitis, the subjects in TennCare Medicaid treated with LTRAs were less likely to experience ED visits (hazard ratio 0.44 [95% CI, 0.21-0.93]) compared with the subjects treated with ICS. For all other groups, the subjects treated with LTRA or ICS-LABA were just as likely to experience ED visits or hospitalizations, or need oral corticosteroids as the subjects treated with ICS.
  
  
  CONCLUSIONS
  Risks of asthma-related exacerbations did not differ between children who initiated LTRA and ICS. These findings may be explainable by LTRA, which has similar effectiveness as ICS in real-life usage by residual confounding by indication or other unmeasured factors.
authors.affiliation: Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: ann.wu@childrens.harvard.edu.
authors.forename: Ann Chen
authors.initials: AC
authors.lastname: Wu
authors.affiliation: Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.affiliation: Department of Research, HealthPartners Institute for Education and Research, Minneapolis, Minn.
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.affiliation: Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Larkin
authors.affiliation: Center for Health Research-Northwest, Kaiser Permanente, Portland, Ore.
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.affiliation: Center for Health Research-Southeast, Kaiser Permanente Georgia, Atlanta, Ga.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.affiliation: Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass.
authors.forename: Donna
authors.initials: D
authors.lastname: Rusinak
authors.affiliation: Center for Health Research-Southeast, Kaiser Permanente Georgia, Atlanta, Ga.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.affiliation: Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Tina
authors.initials: T
authors.lastname: Hartert
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Partners Center for Personalized Genetic Medicine, Partners Health Care, Boston, Mass.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Weiss
authors.affiliation: Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000188:drug therapy / Q000453:epidemiology; D012306:Risk; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists
keywords: Asthma; Controller medications; Effectiveness; Inhaled corticosteroids; Leukotriene antagonist; Long-acting β-agonist