Controller therapy in asians and whites with persistent asthma

Abstract

Background: Little is known concerning the relative effectiveness of LTRAs compared to ICSs as monotherapy or LABA as add-on therapy in the Asian population. Objectives: In this retrospective cohort study, we examined the comparative effectiveness of montelukast to ICS as a first-line monotherapy and as an add-on in comparison with LABA on asthma exacerbations among Asian and non-Hispanic white persistent asthma patients in a large managed care organization. Methods: The three add-on comparisons were montelukast plus low-dose ICS versus LABA plus low-dose ICS, montelukast plus low-dose ICS versus medium-dose ICS, and montelukast plus medium-dose ICS versus LABA plus medium-dose ICS. Patients were identified based on ICD-9 diagnosis codes and administrative pharmacy dispensing. Exacerbations were defined as asthma emergency department visit or hospitalization, or asthma outpatient visits requiring systemic corticosteroid dispensing. Patient demographic and clinical characteristics were balanced by using inverse probability treatment weighting. Multivariable robust Poisson and Cox-proportional hazards regression models were applied to estimate rate ratios and hazard ratios. Results: Compared with low-dose ICS monotherapy, montelukast monotherapy evidenced a lower incidence rate (RR 0.89, CI 0.79-0.99, p = 0.03) but similar hazard rate (HR 0.96, CI 0.86-1.06, p = 0.43) of asthma exacerbation in white patients 12 years of age or older. No difference was observed in Asian patients or in white children 4-11 years of age. All other comparisons did not reveal a statistically significant difference in incidence or hazard rate. Conclusion: In a real-world comparative effectiveness study, asthma exacerbation rates were similar among guideline alternative controller regimens in Asians and whites.