Anti-Leukotrienes as Good as Standard Asthma Therapy

Do not think to much, do not speak to loud, our Hot New Today is about Anti-Leukotrienes as Good as Standard Asthma Therapy - It is a useful information so you have to continue reading this Anti-Leukotrienes as Good as Standard Asthma Therapy articles.

In the "real world" of asthma treatment, leukotriene-receptor agonists (LTRAs) may be just as effective as the gold standard of inhaled glucocorticoids as both a first-line and add-on therapy, researchers said.

Two real-life trials found the drugs were equivalent as monotherapy in symptom reduction at two months and approached equivalence at two years, according to David Price, MD, of the University of Aberdeen in Scotland, and colleagues.


Outcomes were also similar at those two time points when patients who were poorly controlled on a glucocorticoid were given either an LTRA or a long-acting beta-agonist as an add-on, the team reported in the May 5 issue of the New England Journal of Medicine.

Guidelines currently recommend inhaled glucocorticoids as first-line treatment for asthma control in patients with mild persistent disease. Yet the researchers noted that these agents have little effect on the formation or action of cysteinyl leukotrienes -- inflammatory mediators in asthma.

Controlled clinical trials of LTRAs, which target these molecules, have shown that the drugs can help reduce symptoms, but the results of prior comparisons with inhaled glucocorticoids have been mixed.

So Price and colleagues conducted two parallel, multicenter trials to evaluate the "real-world" effectiveness of LTRAs: one that looked at an LTRA versus an inhaled glucocorticoid as first-line therapy, and another that assessed the addition of either an LTRA or a LABA to a glucocorticoid in those whose asthma wasn't well controlled.

All patients were under the care of their usual physicians.

For the first-line trial, 148 patients were given an LTRA and 158 received a glucocorticoid. For the add-on trial, 170 were given an LTRA and 182 were given a LABA.

The researchers found that at two months, the LTRA was equivalent to standard therapy in both the first-line and add-on scenarios in improving quality of life.

At two years, quality of life scores approached equivalence, the researchers said, although confidence interval values fell just shy of the equivalence definition used in the study (-0.35 to 0.13 for first-line and -0.32 to 0.11 for add-on compared with -0.3 to 0.3 as the standard).

Secondary outcome measures were similar for all treatment groups, and rescue bronchodilator use fell equally as well, the researchers said.

But they noted that adherence was notably better for patients on LTRAs -- 65% versus 41% in the first-line study and 74% versus 46% in the add-on trial -- which may be because LTRAs are taken orally and not inhaled.

Price and colleagues also cautioned that in the add-on trial, about a quarter of patients on an LTRA were switched to a LABA or received an add-on LABA.

They suggested that might be because LTRAs are not commonly prescribed in the U.K. as a first-line or as an add-on therapy, so the physicians who were unaware of the study may have switched therapies.

They also noted that the study was limited because the findings apply only to adults, not children, as only those over age 25 were included in the investigation.

In an accompanying editorial, Sven-Erik Dahlen, MD, PhD, of the Karolinska Institute, in Stockholm, and colleagues, said the results "challenge current guidelines."

"We think this alternative approach works in the real-world setting primarily because it is easier to take a pill once or twice a day than to use an inhaler," they wrote.

Also, anti-leukotrienes may be cheaper as generic versions of many of them are expected soon and they have good safety profiles, Dahlen and colleagues wrote.

They concluded that oral leukotriene modifiers "provide an alternative treatment that may help patients pursue their activities of daily life as effectively as inhaled glucocorticoids do."

via:http://www.medpagetoday.com/AllergyImmunology/Asthma/26286