A recently published comparative effectiveness study showed that, in general, patients with asthma had better clinical outcomes with oral controllers than inhaled corticosteroids. The study, performed by HealthCore Inc, Wilmington, Del, appears in the August edition of Mayo Clinic Proceedings.

"WellPoint’s National Pharmacy and Therapeutics Committee requested the comparative effectiveness study to help ensure that its drug formulary for asthma therapies was aligned with their real-world use and outcomes," said Joseph Singer, MD, vice president of clinical affairs for HealthCore in an announcement. "We believe the study to be the first comprehensive comparative effectiveness research study on all asthma controller medications."

The study found that users of oral controllers were significantly better at adhering to their medication than users of inhaled corticosteroids and, according to researchers, probably obtained greater treatment benefit.

"Clinical superiority of the inhaled products has been well documented in clinical trials and the HealthCore study confirmed this for those who take their medication properly," Singer said. "However, we were surprised to discover that in looking at all patients in real-world settings, oral controllers appeared to be a better choice of treatment because of better compliance. Patients with the best outcomes were those who were compliant with inhaled corticosteroids."

"It’s important for physicians and health plans alike to know that ‘one size fits all’ does not apply when treating asthma patients," said Singer. "These results speak to the power of comparative effectiveness research and its ability to give physicians the information they need to customize treatment for patients in the real world."

The comparative effectiveness research study assessed the following outcomes:
– Use of short-acting beta-agonists;
– Use of oral corticosteroids;
– Inpatient/emergency room visits; and
– Total cost of care attributable to asthma during the 12-month period after the index date.

Both oral and inhaled treatments offered comparable impacts on patient-reported quality of life and productivity. Among patients taking more than one drug to control their asthma, researchers found that a combination of inhaled corticosteroids and long-acting beta-agonists were the best course of treatment in terms of better clinical outcomes and better quality of life.

The authors concluded that patients who were compliant with their inhaled corticosteroids had better outcomes than those who adhered to their oral controllers, but so few of those taking inhaled corticosteroids adhered properly to their medication that it had little impact on the overall population studied.