23. Inhaled steroids better than leukotriene antagonists for asthma maintenance
In 2000 a systematic review of 10 randomised controlled trials comparing inhaled steroids to the recently-introduced leukotriene-receptor antagonists found the former to be superior in terms of asthma control. Notwithstanding this analysis, doctors continue to prescribe leukotriene antagonists, and in 2001 sales volumes in the US were equal for the two groups of agents. In light of the latter statistic a systematic review was repeated covering 13 randomised controlled trials (12 adult, 1 paediatric). The study was based on steroid dosages equivalent to 400-500microgm of beclomethasone vs anti-leukotrienes, i.e. patients with mild to moderate asthma. Patients treated with anti-leukotrienes were significantly more likely to have exacerbations (that then required steroids) while steroid users had significantly better FEV 1 results and morning peak expiratory flow rates, fewer nocturnal awakenings, more days without symptoms and less resort to rescue bronchodilators. Furthermore, anti-leukotriene users were significantly more likely to stop treatment because of poor asthma control. While it is acknowledged that the data apply to adults and that there is a chance that children might behave differently, the most important question relates to how one can improve the dissemination of information and promote conversion of research and meta-analysis into evidence-based practice

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BMJ 2003;326:621-3 J
Watch 2003;23:74