Once-daily outperforms twice-daily inhaled steroid in asthma (Medscape) - Dec 12, 2011 - P=NA, N=11,841; Among FP patients more exacerbations were found than among MF patients (p=.0263) and more SABA fills in the postindex period (p<0.001); MF pateints also had more prescription fills, suggesting better adherence (p<.0001)
Clinical data • Asthma
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In treatment-naïve patients with mild persistent asthma, mometasone furoate (MF) was associated with fewer exacerbations and less short-acting β2-agonist (SABA) use than fluticasone propionate (FP). This finding was presented here at the World Allergy Organization XXII World Allergy Congress.
There have been few studies comparing different inhaled corticosteroids in asthma management. The researchers conducted a retrospective claims analysis comparing MF and FP inhalers in asthma patients who had not used any previous asthma control medications. Outcomes included exacerbation events, SABA use, and adherence (measured as asthma controller medication prescription fills).
"Mometasone furoate and fluticasone propionate are commonly prescribed medications, and mometasone furoate is one of the only inhaled steroids that's approved for once-daily dosing. The intent was to examine the impact of the once-daily dosing and the flexibility that that affords patients," presenter Felicia Allen-Ramey, PhD, director of the Merck global health outcomes respiratory team, told Medscape Medical News.
The study involved 11,841 patients 12 to 65 years of age with mild persistent asthma who were enrolled in the Ingenix LabRx database from October 2001 to December 2007.
The index event was defined as the first FP or MF fill. The researchers examined outcome data 180 days prior to and 365 days after the index event. They matched 3046 patients (1523 per cohort) using a 1:1 propensity score on preindex demographic and use characteristics.
The investigators found more exacerbations among FP patients than among MF patients (mean, 0.21 vs 15.0; P = .0263) and more SABA fills in the postindex period (mean, 1.50 vs 1.20 canisters; P
"Mometasone furoate is a potent inhaled steroid, as they all are, but given that patients have difficulty remembering to take their medications twice a day, [once-daily dosing] gives physicians the option to still deliver that recommended controller medication and a way for patients to simplify their dosing regimen," said Dr. Allen-Ramey.
"It raises some interesting questions about patient preference — why they might be more willing to refill once a day than twice a day," Stanley Szefler, MD, head of pediatric clinical pharmacology at National Jewish Health in Denver, Colorado, who comoderated the session, told Medscape Medical News.
The study made good use of claims data, which providers are beginning to use more and more to decipher patient behavior patterns and outcomes. "It's a new area of research," said Dr. Szefler.
The study was funded by Merck. Dr. Allen-Ramey is an employee of Merck. Dr. Szefler reports being a consultant for Merck and chair of a pediatric steering committee for a study being conducted by GlaxoSmithKline.
World Allergy Organization XXII World Allergy Congress (WAC): Abstract 3197. Presented December 6, 2011.
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