Asthma drugs don't produce a uniform response in young patients. This can make it hard for doctors to know what to prescribe to control the condition, which is marked by chronic airway inflammation and constriction. But by combining a simple blood test with a pulmonary function test, as described in the February Journal of Allergy and Clinical Immunology, doctors may be able to tailor therapies to specific patients more accurately. The tests use biomarkers to predict children's response to two popular asthma drugs -- Flovent, an inhaled steroid, and Singulair, one of a newer category of drugs called leukotriene receptor antagonists, which is taken orally.
No Guessing In the new study, researchers from the National Heart, Lung, and Blood Institute's Childhood Asthma Research and Education Network (CARE) assessed the responses of 126 children with mild to moderate asthma taking either of the two drugs. The 29 children with low pulmonary function or elevated allergic inflammation (measured in various ways, including by blood levels of immunoglobulin E, an antibody that forms after the body is exposed to an allergen) responded better to Flovent. Twenty-two children with normal pulmonary function and normal levels of allergic inflammation responded equally well to Flovent and Singulair. Sixty-nine of the kids, or more than half, responded to neither medication.
Singulair: More effective for some young asthma patients than others; a test can predict response.
(Merck & Co.)
Targeted Treatment Lead author Stanley J. Szefler, head of pediatric clinical pharmacology at the Colorado-based National Jewish Medical and Research Center, which participates in CARE, called the study the first to compare the effects of these two common drugs with measurable biomarkers of asthma. "The physician is often faced with making a decision by either cost or convenience," Szefler said. "These kinds of markers, over time, hopefully will be used to try to get the patients the medication that's most likely to work."
-- January W. Payne