Montelukast

Objective:

To evaluate the 1-year risk of asthma exacerbations, hospitalizations, and rescue, acute, and allergy medication use among children receiving montelukast or other step 3 asthma controller therapy

Design:

2-year pre-post retrospective cohort study

Setting:

Pedianet database in Italy

Participants:

Children <15 years old with asthma

Main exposure:

≥2 consecutive asthma controller prescriptions, including increased inhaled corticosteroid (ICS) dose, long-acting β2 agonist (LABA), or montelukast over 1 year

Outcome measures:

Post- to pre-index within-cohort changes in exacerbation risk and asthma-related medication; differences were tested with a paired McNemar test. The 1-year risk of exacerbation was compared between cohorts by logistic regression analysis and medication use/cost, by linear regression.

Results:

Of 987 children (61% male), 122 received montelukast (~75% as add-on to ICS) and 865, other controllers (677 high-dose ICS, 187 ICS-LABA, 1 LABA). The montelukast cohort was older and had more severe asthma. The 1-year risk of exacerbation decreased in the post-period from 48.4% to 38.5% (P = 0.12) in the montelukast cohort and increased from 29.7% to 35.1% (P = 0.016) in the other controller cohort. Pre- to post-index prescription rates of oral corticosteroids and rescue medication fell significantly (P < 0.05) in the montelukast cohort; user and prescription rates of oral corticosteroids, antibiotics, and rescue medication increased significantly (P < 0.05) in the other controller cohort.

Conclusion:

Montelukast as add-on asthma controller therapy reduces the prescription rates of oral corticosteroids and rescue medication.