Asthma pill performed similarly to glucocorticoids, LABAs

Leukotriene-receptor antagonists (LTRAs) controlled asthma as effectively as more commonly recommended treatments, according to a new report of two pragmatic trials.

The first of the trials included 300 British primary care patients between 12 and 80 years old who had inadequate asthma control or impaired asthma-related quality of life. The patients were randomized to either an LTRA or an inhaled glucocorticoid as their first-line asthma therapy. The second trial included 350 similar patients who were already taking an inhaled glucocorticoid as first-line therapy, and they were randomized to either an LTRA or a long-acting beta-agonist (LABA) as add-on therapy. The groups' scores on the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) were compared during the following two years of open-label treatment. Results appeared in the May 5 New England Journal of Medicine.

Overall, mean MiniAQLQ scores increased during the two years. After two months of treatment, scores were equivalent between patients taking LTRA or other drugs in both trials. After two years of treatment, the scores were almost equivalent, but they did not meet the study authors' prespecified, and intentionally conservative, criterion for equivalence (mean difference between groups, −0.11), with the other drugs slightly outperforming LTRAs.

Adherence to an LTRA was better than to the other drugs (65% vs. 41% for the first trial, 74% vs. 46% for the second), probably because it's easier to take a pill than use an inhaler, noted an accompanying editorial. The editorialists noted other advantages to LTRAs, including their effects on comorbidities such as rhinitis and ease of use in the developing world.

The study authors urged caution in interpreting their results, since the trials were limited by lack of a placebo control and crossover between treatment groups. However, the pragmatic trial design did allow analysis of adherence, as well as inclusion of patients who would typically be excluded from such research. Almost a quarter of the studied patients were smokers, and 3% may have had chronic pulmonary obstructive disease, making them more like real-world patients than typical study populations.