PURPOSE:There are few data investigating the role of increased body mass index (BMI) in predicting response to asthma therapy. We analyzed the effect of increasing BMI on achieving control with fluticasone propionate/salmeterol via Diskus (FSC) compared with montelukast (MON).
METHODS:A retrospective analysis was undertaken using available data from US GSK asthma studies (SAS40020, SAS40021, SAS40036 and SAS40037). Treatment comparisons included FSC 100/50 mcg BID and MON 10 mg QD. Outcomes assessed at 12 weeks for each treatment group by baseline BMI (kg/m2) included (1) morning pre-dose FEV1, (2) daily asthma symptom score, (3) daily albuterol use and (4) nighttime awakenings.
RESULTS:The percent change in morning pre-dose FEV1 was as follows: òBMI <20: FSC 13.66±2.96* (n=44), MON 3.76±3.07 (n=37); òBMI ≥20 - <25: FSC 15.64±1.43*å (n=215), MON 4.60±1.34 (n=205); òBMI ≥25 - <30: FSC 14.82±1.29*å (n=258), MON 3.88±1.22 (n=259); òBMI ≥30 - <35: FSC 11.88±1.72* (n=120), MON 1.96±1.88 (n=121); òBMI ≥35 - <40: FSC 12.32±2.65* (n=59), MON 1.03±2.26 (n=56); òBMI ≥40: FSC 8.40±2.83* (n=47), MON -0.67±2.37 (n=49) [*p<0.007 v. MON; åp<0.01 v. BMI ≥40 for FSC].Daily asthma symptom score, daily albuterol use and nighttime awakenings followed a similar pattern as lung function.
CONCLUSION:BMI ≥25 appears to blunt the response to asthma therapy but the superiority of FSC compared to MON persists over the entire range of BMIs.
CLINICAL IMPLICATIONS:BMI may be an important consideration when choosing treatments for patients with asthma. Addressing issues of weight reduction may be an important aspect of asthma treatment for patients with higher BMI.
DISCLOSURE:Thomas Ferro, Employee GSK; No Product/Research Disclosure Information