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Antileukotriene Agents Versus Long‐Acting Beta‐Agonists in Older Adults with Persistent Asthma: A Comparison of Add‐On Therapies
Author(s) -
Altawalbeh Shoroq M.,
Thorpe Carolyn T.,
Zgibor Janice C.,
KaneGill Sandra,
Kang Yihuang,
Thorpe Joshua M.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14235
Subject(s) - medicine , asthma , odds ratio , emergency department , cohort , pediatrics , emergency medicine , physical therapy , psychiatry
Objectives To compare the effectiveness and cardiovascular safety of long‐acting beta‐agonists ( LABA s) with those of leukotriene receptor antagonists ( LTRA s) as add‐on treatments in older adults with asthma already taking inhaled corticosteroids ( ICS s). Design Retrospective cohort study. Setting Medicare fee‐for‐service ( FFS ) claims (2009–10) for a 10% random sample of beneficiaries continuously enrolled in Parts A, B, and D in 2009. Participants Medicare beneficiaries aged 66 and older continuously enrolled in FFS Medicare with Part D coverage with a diagnosis of asthma before 2009 treated exclusively with ICS s plus LABA s or ICS s plus LTRA s (N = 14,702). Measurements The augmented inverse propensity‐weighted estimator was used to compare the effect of LABA add‐on therapy with that of LTRA add‐on therapy on asthma exacerbations requiring inpatient, emergency, or outpatient care and on cardiovascular ( CV ) events, adjusting for demographic characteristics, comorbidities, and county‐level healthcare‐access variables. Results The primary analysis showed that LTRA add‐on treatment was associated with greater odds of asthma‐related hospitalizations or emergency department visits (odds ratio ( OR ) = 1.4, P < .001), as well as outpatient exacerbations requiring oral corticosteroids or antibiotics ( OR = 1.41, P < .001) than LABA treatment. LTRA add‐on therapy was also less effective in controlling acute symptoms, as indicated by greater use of short‐acting beta agonists (rate ratio = 1.58, P < .001). LTRA add‐on treatment was associated with lower odds of experiencing a CV event than LABA treatment ( OR = 0.86, P = .006). Conclusion This study provides new evidence specific to older adults to help healthcare providers weigh the risks and benefits of these add‐on treatments. Further subgroup analysis is needed to personalize asthma treatments in this high‐risk population.