From Our 2011 Archives
Study: Pills as Effective as Inhalers for Asthma
Researchers Say Singulair and Accolate Work as Well as Steroid Inhalers
By Salynn Boyles
Reviewed by Laura J. Martin, MD
May 4, 2011 -- The drugs Singulair and Accolate proved to be just as effective as steroid inhalers for the prevention of asthma symptoms with better patient compliance in two new studies published in this week's New England Journal of Medicine.
Both drugs are leukotriene receptor antagonists (LTRAs) and both were approved more than a decade ago as alternatives to "preventer" inhalers. But they are not as widely used and some studies have found them to be less effective for asthma control in patients with mild persistent asthma.
LTRAs and Asthma Control
The new studies were conducted in the U.K. In one, patients with chronic asthma were treated daily with an LTRA or an inhaled steroid to prevent asthma attacks. In another an LTRA or an inhaled long-acting bronchodilator (LABA) was added to treatment with an inhaled steroid.
All the asthma patients continued to use short-acting "rescue" inhalers when needed to open constricted airways and help them breathe when asthma attacks occurred.
Unlike earlier studies, which excluded up to 95% of asthma patients for one reason or another, the only patients excluded from the two studies were those with terminal cancer or a diagnosis of chronic obstructive pulmonary disease (COPD), researcher Stanley Musgrave, MD, of the University of East Anglia in Norwich, U.K. tells WebMD.
"The drug licensing trials excluded the elderly, smokers, those who were depressed, diabetics and a long list of other conditions that people actually have," he says. "The intent was to determine how well the drugs work in the best of circumstances, but that doesn't necessarily tell you how real people do on particular treatments."
Pills vs. Inhalers
In both trials, the LTRAs appeared to work as well as the inhaled treatments for preventing asthma symptoms over two years of follow-up, and in both trials, patients in the LTRA sections of the study proved to be more compliant with the treatments.
Rates of treatment adherence were 65% and 74% among patients who took the LTRA pills, compared to 41% and 46% among patients treated with the preventive inhaled steroids.
"We think this alternative approach works in the real-world setting primarily because it is easier to take a pill once or twice a day than to use an inhaler," asthma researcher Sven-Erik Dahlen, MD, PhD, of Stockholm, Sweden's Karolinska Institute and colleagues write in an editorial.
The oral drugs have traditionally been more expensive than inhaled prevention treatments, but Dahlen says this should soon change as generic versions of both Singular and Accolate enter the market.
"These drugs are an acceptable alternative to the traditional first-line preventive treatments," he tells WebMD. "In general practice, where these drugs are most often prescribed, there may not be enough time to teach patients how to properly use inhalers. With a pill we may see much better compliance."
The two studies were commissioned and largely funded by the U.K.'s National Health Service.
Merck & Co., which makes Singulair, and AstraZeneca, which makes Accolate, provided some funding, but Musgrave says the companies were not involved with the design or execution of the study or the interpretation of the results.
Musgrave says even though the oral drugs appear to be as effective for the prevention of asthma symptoms, they may not be the best choice for every patient.
"Patients should talk to their doctors to determine the treatment that might work best for them," he says.
Merck issued a statement saying that the company is pleased that independent researchers are showing continued interest in evaluating the use of leukotriene receptor antagonists, including Singulair, as an important option for treating asthma in appropriate patients.
SOURCES: Price, D. The New England Journal of Medicine, May 5, 2011; vol 264: pp 1695-1707.Stanley D. Musgrave, MD, senior research associate, Norwich Medical School, University of East Anglia, U.K.Sven-Erik Dahlen, MD, PhD, Karolinska Institute, Stockholm, Sweden.News release, New England Journal of Medicine.©2011 WebMD, LLC. All Rights Reserved.