More Evolution of the Evidence in Asthma Disease Management-SMART Versus GOAL Clinical Trials Debate the Cost-Benefit of LABA While the Value of Leukotriene Modifiers, Particularly Montelukast, Is Uncertain

The Editors Respond: The Diminishing Role of Montelukast in Asthma Therapy

“…10 The claim by Markson et al that the higher use of SABAs in the ICS-montelukast group represents only "approximately 1.2 canisters per person per year (4.36 versus 3.16)" is, in fact, 38% higher relative use of SABAs. We also take the position that SABA use is arguably more clinically relevant and significant since SABA use is a common clinical marker used by physicians and can be used to detect poor asthma control prior to hospital or emergency department admission.…”

Omalizumab and Other New Drug Therapies Occupy a Small Space in Asthma Disease Management

“…12 In fact, it is impressive that 59% of patients in the GOAL study with previously uncontrolled asthma were well controlled at 1 year with higher doses of fluticasone alone, and 71% of patients were well-controlled with higher doses of fluticasone plus LABA. 13 However, the persistence of symptoms in some patients with severe asthma despite treatment invites continued research on the pathophysiology of asthma. In fact, the NAEPP update in 2007 recommended use of omalizumab in a more narrow corridor than stated in the omalizumab product label approved 4 years earlier by the FDA (i.e., appropriate for use only in patients with "severe persistent asthma" versus the FDA-approved labeling that includes patients with "moderate-to-severe persistent asthma").…”

Health Care Utilization Determined From Administrative Claims Analysis for Patients Who Received Inhaled Corticosteroids With Either Montelukast or Salmeterol

“…Crownover 1 and Curtiss 2 published separate editorials that made reference to our article 3 on health care utilization among patients with asthma who were treated with inhaled corticosteroids (ICSs) in combination with either montelukast (MON) or salmeterol (SAL). The subject of Crownover' s editorial is application of the PP-ICONS tool 4 to skim research articles to quickly evaluate new publications.…”

“…Montelukast was cited in the company' s 2005 annual report as the leader in sales performance, among its portfolio of products, 1 and montelukast is projected to be the leading product in sales for the manufacturer through 2009. 2 Montelukast costs about $1,100 per patient per year at discounted managed care organization prices in the United States in 2006; in the 3 months ending May 31, 2006, it pushed its way to be the overall fourth-highest expenditure drug. 3 Any potentially negative information about montelukast would understandably be of great concern to the manufacturer and its employees.…”