Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

LTRA as first-line or add-on in Asthma

The New England Journal of Medicine has published the results of a study that aimed to assess the efficacy of leukotriene receptor antagonists (LTRA) in controlling asthma as a first-line treatment compared to inhaled corticosteroids (ICS) or as an add-on treatment compared to long acting beta agonists (LABA). This study has been reported in the general media (Daily Mail and Daily Telegraph)

The trial was operated as two parallel, randomised, open-label studies that ran for 2 years in several centres. 306 patients were involved in the ICS versus LTRA study with 158 given an ICS and 148 given LTRA. 352 patients were involved in the LABA versus LTRA study with 182 given LABA and 170 given LTRA. Participants were aged 12 to 80 years old and had poor quality of life or asthma control.

Patients were enrolled and efficacy was assessed using the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) or the Asthma Control Questionnaire (ACQ).

At a predefined early assessment conducted at 2 months, LTRA was equivalent to the comparator treatment however at the full 2 year follow up equivalence could not be demonstrated. Additionally, interpretation may be difficult due to a large proportion of crossover between treatment arms seen in the study. In the LABA versus LTRA study, a quarter of patients assigned to treatment with LTRA were either switched to or co-prescribed a LABA.

Unfortunately, media reporting of this study has exaggerated the findings with headlines stating, "Pills better for treating asthma than inhalers" and "Once-a-day asthma pill 'is more effective than inhaler'".

Action: Clinicians should be aware of this study and the exaggerated media reporting. This study provides no reason to deviate from the current British Thoracic Society Asthma Guideline.

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