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WAM: Fluticasone Superior to Montelukast for Initial Asthma Controller Therapy By W. A. Thomasson Special to DG News CHICAGO, IL -- July 16, 2001 -- Inhaled fluticasone (88 µg twice daily) has proved superior to oral montelukast (10 mg daily) on a variety of measures of asthma control. This finding was presented at the World Asthma Meeting by Courtney Crim, MD, of GlaxoSmithKline in Research Triangle Park, North Carolina. The data were from two identical studies that enrolled a total of 1055 patients who were inadequately controlled on short-acting beta-agonists but were not receiving controller therapy. Baseline FEV1(Forced expiratory volume at one second)- was 50-80 percent of predicted normal, with at least a 15 percent increase after albuterol use. After 24 weeks, FEV1 had increased by 22.5 percent in fluticasone-treated patients and 14.2 percent in montelukast-treated patients; albuterol use had decreased 59.3 percent and 43.3 percent, respectively; and symptom scores had decreased by 51.1 percent and 31.7 percent. All differences are significant at the p=0.001 level, and differences in FEV1 were statistically significant at every two-week interval throughout the study. Differences in peak expiratory flow, nighttime awakenings, and symptom-free days were also significant. There were likewise significantly more patients who identified themselves as "satisfied" with fluticasone therapy than with montelukast therapy - 84 percent versus 69 percent. In addition, 69 percent of physicians rated fluticasone "effective" or "very effective," while only 53 percent did so for montelukast. Other papers presented at the meeting suggest that oral therapy may lead to significantly better compliance, especially in young patients, and may therefore offer "real world" advantages. These data, on the other hand, indicate that inhaled corticosteroids can offer inherently superior asthma control when compliance is good. E-mail this page to a friend or colleague! To print, use this version