Pragmatic Trials Point to Equivalence of LTRAs for Asthma
Major Finding: Leukotriene antagonists showed equivalence with inhaled glucocorticoids as first-line therapy for asthma and with beta-agonists as add-on therapy for asthma at 2 months and at 2 years on several measures, but fell just short of demonstrating equivalence on the primary end point at 2 years.
Data Source: Two parallel, multicenter "pragmatic" trials to assess the real-world effectiveness of leukotriene antagonists compared with inhaled glucocorticoids as first-line treatment and compared with long-acting beta-agonists as add-on therapy for poorly controlled asthma.
Disclosures: This study was supported primarily by the U.K. Health Technology Assessment Programme; additional support was provided by Clement Clarke International, Merck Sharp & Dohme, AstraZeneca, and Research in Real Life. Dr. Price and his associates reported numerous ties to industry sources.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
They added, "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. The data from the two studies support this view, since the rates of adherence to the oral LTRAs were 65% and 74% in the first-line controller and add-on therapy trials, respectively, compared with only 41% and 46% for the inhaled glucocorticoid."
This study was supported primarily by the U.K. Health Technology Assessment Programme. Additional funding for the study was provided by Clement Clarke International, Merck Sharp & Dohme, AstraZeneca, and Research in Real Life. Dr. Price and his associates reported numerous ties to industry sources. Dr. Ware and Dr. Hamel reported no conflicts of interest. Dr. Sven-Erik Dahlen reported ties to Regeneron Pharmaceuticals and GlaxoSmithKline, and Dr. Barbro Dahlen reported ties to Actelion and Genentech.
