Montelukast Use and Patterns of Ambulatory Care among Asian versus Non-Asian Adult Patients with Asthma and/or Allergic Rhinitis in the United States

Background: Asthma and allergic rhinitis (AR) are inflammatory conditions that are similar in pathophysiology. Mild-to-moderate persistent asthma has been widely treated with inhaled corticosteroids, while allergic rhinitis is commonly treated with antihistamines, nasal corticosteroids, anticholinergics, and other allergy specific medications. The introduction of montelukast, a leukotriene receptor antagonist, has opened a treatment pathway that is common to both conditions. Previous real world studies of montelukast (Singulair®) relative to other medications have not investigated the role of race in the management of asthma and AR, specifically as relates to differences among Asian versus non-Asian patients. Objective: To contrast montelukast use and patterns of ambulatory care for adult Asian versus non-Asian patients in the United States with asthma and/or AR. Methods: Data for adult asthma and AR patients were extracted from a national electronic medical records database for the years 2006-2014. Patients were classified into condition cohort (Asthma-Only, AR-Only, Asthma & AR), and treatment condition (monotherapy or combination therapy, with or without montelukast for Asthma and Asthma & AR cohorts, usual care with or without montelukast for AR-Only) and stratified by race (Asian vs. non-Asian). Results: Overall patterns of use of montelukast were similar for Asian and non-Asian patients, but Asians were more likely to receive it as part of a combination therapy regimen. Changes in treatment regimen followed similar patterns for both groups. Asian patients with both asthma and AR were found to have lower service utilization rates if their therapy included montelukast, whereas for non-Asians there was no significant difference between regimens with or without montelukast. Conclusion: Differences in montelukast use and outcomes of care exist between Asian and non-Asian patients in the United States. Future research should explore the reasons for these differences and whether they can be replicated in non-US settings.