Abstract: Slide Presentations |

Asthma Control With Montelukast or Salmeterol As Add-On Therapy To Inhaled Corticosteroid Treatment of Asthma FREE TO VIEW

David Anstatt, MBA; Felicia C. Allen-Ramey, PhD; James Korelitz, PhD; James Bethel, PhD; Shiva Sajjan, PhD; Leona Markson, ScD
Author and Funding Information

Merck & Co., Inc., West Point, PA


Chest. 2003;124(4_MeetingAbstracts):94S. doi:10.1378/chest.124.4_MeetingAbstracts.94S-a
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PURPOSE:  To assess the impact of combination therapy of inhaled corticosteroid plus montelukast (MON) or salmeterol (SAL) on asthma-related acute events [inpatient (IP) admissions and emergency department (ED) visits] and rescue medication use [oral corticosteroid (OCS) and short-acting beta-agonist (SABA)].

METHODS:  Using the PHARMetrics managed care claims database, patients on ICS therapy who added MON or SAL between 07/01/98 and 06/30/99 (index prescription) aged 4–55 years were identified. Patients with 12-month pre- and post-index observation time were included. The mean annual rate per 100 patients per year (claims) of asthma-related IP admissions, ED visits, OCS use and SABA use in the post-index period were analyzed. Poisson models were used to estimate rates of post-index asthma-related resource use, adjusting for propensity score, index treatment, comorbid conditions, pre-index resource use, and pre-index asthma costs.

RESULTS:  3,171 patients on ICS initiated a second controller medication (MON=765, SAL=2406). A significant difference in post-index ED visits was observed (adjusted rate: ICS/SAL = 9 claims vs. ICS/MON=5 claims, p<.001) with an increase in rate among ICS/SAL patients (3 claims) and a decrease among ICS/MON patients (3 claims). A significantly greater adjusted post-index rate of claims for SABA use was found with use in ICS/MON patients (465 claims) compared to ICS/SAL (352 claims, p<.001). No significant difference between treatment groups was observed in adjusted post-index IP (ICS/MON=10.0 claims vs. ICS/SAL=10.5 claims; p=0.68) or adjusted post-index OCS use (ICS/SAL=45 claims vs. ICS/MON=53 claims, p=.06).

CONCLUSION:  In this retrospective analysis, ICS/MON therapy was associated with lower rate of ED visits and a higher rate of SABA compared to ICS/SAL therapy. Similar rates of IP and OCS use were observed among patients in the two combination therapy groups.

CLINICAL IMPLICATIONS:  The addition of Montelukast to ICS results in fewer ED visits while the addition of a long acting beta agonist such as Salmeterol to ICS results in less SABA use.

DISCLOSURE:  D. Anstatt, Merck & Co., Inc., Industry.

Tuesday, October 28, 2003

10:30 AM - 12:00 PM




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