title: Antileukotriene Agents Versus Long-Acting Beta-Agonists in Older Adults with Persistent Asthma: A Comparison of Add-On Therapies.
abstract: To compare the effectiveness and cardiovascular safety of long-acting beta-agonists (LABAs) with those of leukotriene receptor antagonists (LTRAs) as add-on treatments in older adults with asthma already taking inhaled corticosteroids (ICSs).
  
  
  
  Retrospective cohort study.
  
  
  
  Medicare fee-for-service (FFS) claims (2009-10) for a 10% random sample of beneficiaries continuously enrolled in Parts A, B, and D in 2009.
  
  
  
  Medicare beneficiaries aged 66 and older continuously enrolled in FFS Medicare with Part D coverage with a diagnosis of asthma before 2009 treated exclusively with ICSs plus LABAs or ICSs plus LTRAs (N = 14,702).
  
  
  
  The augmented inverse propensity-weighted estimator was used to compare the effect of LABA add-on therapy with that of LTRA add-on therapy on asthma exacerbations requiring inpatient, emergency, or outpatient care and on cardiovascular (CV) events, adjusting for demographic characteristics, comorbidities, and county-level healthcare-access variables.
  
  
  
  The primary analysis showed that LTRA add-on treatment was associated with greater odds of asthma-related hospitalizations or emergency department visits (odds ratio (OR) = 1.4, P < .001), as well as outpatient exacerbations requiring oral corticosteroids or antibiotics (OR = 1.41, P < .001) than LABA treatment. LTRA add-on therapy was also less effective in controlling acute symptoms, as indicated by greater use of short-acting beta agonists (rate ratio = 1.58, P < .001). LTRA add-on treatment was associated with lower odds of experiencing a CV event than LABA treatment (OR = 0.86, P = .006).
  
  
  
  This study provides new evidence specific to older adults to help healthcare providers weigh the risks and benefits of these add-on treatments. Further subgroup analysis is needed to personalize asthma treatments in this high-risk population.
authors.affiliation: Center for Clinical Pharmaceutical Sciences, Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Shoroq M
authors.initials: SM
authors.lastname: Altawalbeh
authors.affiliation: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.|Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Janice C
authors.initials: JC
authors.lastname: Zgibor
authors.affiliation: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kane-Gill
authors.affiliation: Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
authors.forename: Yihuang
authors.initials: Y
authors.lastname: Kang
authors.affiliation: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.|Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000318:Adrenergic beta-Agonists / Q000009:adverse effects* / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020024:Leukotriene Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D003692:Delayed-Action Preparations; D020024:Leukotriene Antagonists
keywords: Medicare; asthma; cardiovascular; older adults