Severe Asthma Attacks in Kids Averted by Fluticasone/salmeterol Combo

From Reuters Health Information

NEW YORK (Reuters Health) Nov 11 - In asthmatic children, treatment with fluticasone plus salmeterol is associated with fewer serious exacerbations and lower medical costs compared to the use of an inhaled corticosteroid (ICS) plus montelukast.

That's according to a retrospective study of insurance claims data presented by Dr. Richard Stanford, from GlaxoSmithKline in Research Triangle Park, North Carolina, at the annual scientific meeting of the American College of Allergy, Asthma and Immunology in Miami Beach, Florida.

Clinical trials in adults have shown that combining ICS with a long-acting beta-agonist such as salmeterol produces greater lung function improvements than combining the ICS with the leukotriene antagonist montelukast, Dr. Stanford told Reuters Health.

He added, "NIH asthma treatment guidelines recommend ICS plus a long-acting beta-agonist as one of two preferred therapies for children 4 to 11 years of age requiring medications greater than ICS monotherapy; the other preferred therapy is doubling the dose of ICS. ICS plus montelukast is an alternative therapy."

Using data from 2000 to 2008, Dr. Stanford and his colleagues identified 747 pairs of children, ages 4 to 11, on the two drug regimens. Pairs were matched in pre-index-date oral and inhaled corticosteroid use and respiratory-related hospitalizations and emergency department visits.

Results showed that, per 100 person-years, patients who started fluticasone/salmeterol had a significantly lower rate of asthma-related hospital inpatient visits (0.29 vs 33.91, adjusted hazard ratio 0.039) compared with the ICS/montelukast group. The corresponding rates of asthma-related emergency department plus inpatient events were 13.02 vs 56.84 (adjusted HR 0.44; p < 0.02 for both).

Average monthly costs for asthma treatment were $151 less in the fluticasone/salmeterol group than in the ICS/montelukast group.

"These data showed that fluticasone/salmeterol combination was associated with lower asthma-related serious exacerbations compared to ICS/montelukast in patients 4 to 11 years of age in a managed care setting," Dr. Stanford concluded.

GlaxoSmithKline markets the combination of fluticasone/salmeterol internationally under several trade names, including Advair in the United States.