Comparing outcomes in patients with persistent asthma: a registry of two therapeutic alternatives.

Objective: Clinical trials have demonstrated improved efficacy of fluticasone propionate/ salmeterol ( 100/ 50 mcg) in a single device ( FSC) compared with montelukast ( 10 mg) ( MON). This study was designed to assess asthma control, asthma- related quality of life, asthma- related emergency department ( ED) visit/ hospitalization, treatment- related satisfaction, and productivity losses in patients newly started on FSC or MON. Research design and methods: Patients who were newly prescribed FSC or MON during a regularly scheduled office visit were enrolled in a prospective observational study by nearly 500 physicians from eight managed care plans. Patient survey data were collected at baseline and at months 1, 3, 6, and 12, to measure study outcomes. ED visits/ inpatient stays were reported from commercial claims data. Multivariate analyses assessed 12- month outcomes, controlling for several baseline patient characteristics. Results: A total of 1414 patients 15 years old were enrolled in the registry ( FSC, n = 1061; MON, n = 353), 90% of which completed a 12- month survey. FSC patients had significantly greater improvement in both asthma control and quality of life, and reported significantly higher satisfaction with their medication ( p = 0.003) and fewer days at work/ school with asthma symptoms ( p = 0.04) than MON. Other parameters of productivity losses such as missed work/ school days due to asthma were not significantly different between the two groups. FSC use was also significantly associated with a lower risk of an asthma- related ED visit/ hospitalization compared with MON ( odds ratio = 0.35, 95% confidence interval: 0.15 - 0.92). Conclusion: In a 12- month office- based observational study, patients age 15 and older with persistent asthma, newly started on FSC, improved in symptom, quality of life, treatment, and utilization- related outcomes compared with patients newly started on MON. These results should be interpreted in light of the inherent limitations of non- randomized, uncontrolled studies.