Pharmacy & Therapeutics- August 2008 - (Page 455) Monitoring Asthma Control compare traditional agents such as beclomethasone (e.g., BecMontelukast (N = 337) 50 lovent, GlaxoSmithKline) with Beclomethasone (N = 329) newer products like monte lukast (Singulair, Merck) (Fig40 ure 1).11 Genetically mediated variations in response to pharmacotherapeutic agents may result 30 in erratic or unreliable asthma control for patients. The emerging field of pharmacogenetics 20 has allowed researchers to identify polymorphisms associated with individual variability in 10 response to therapy for asthma (Figure 2).12 Because genetic markers for variations of asthma 0 response are not yet widely 0–10 >10–20 >20–30 >30–40 >40–50 >50–60 >60–70 >70–80 >80–90 >90– available, we cannot easily pre100 dict the variation in patients’ clinical responses and their outFigure 1 Days of asthma control, expressed as the percentage of patients receiving comes. montelukast (Singulair) and beclomethasone (e.g., Beclovent). (From Israel E, Chervinsky These variations in response PS, Friedman B, et al. J Allergy Clin Immunol 2002;110(6):847–854. Reproduced with permisto therapy have been observed sion from Elsevier.11) in well-controlled clinical trials, which are designed to address various environmental factors and patients’ compliance with lation-based clinical outcomes. This is the dilemma facing guidelines. In treating patients in real-world practice, we would health plans today. expect to find even more variations of response and of popuPatients, % 50 Adult Study CAMP ACRN IDENTIFYING PATIENTS WITH UNCONTROLLED ASTHMA Effectiveness of Claims Data Among actual patient populations, computerized predictive models based on administrative claims are limited in their ability to identify patients with asthma who are at high risk.13,14 Such models often show a lower correlation with patients’ actual use of therapy than in other chronic diseases such as heart failure and diabetes. Those diseases appear to have a more predictable pattern, with an associated progressive decline in clinical status without treatment. This pattern does not hold true with asthma; patients may improve, decline, or experience a variable course, independent of their level of therapy. Even though retrospective and administrative claims data are a crucial component to a comprehensive strategy for identifying 40 Patients, % 30 20 10 0 40 Figure 2 Improvements in lung function among asthma patients with CRHR1 genetic variants taking inhaled corticosteroids for eight weeks in the Adult Study and the Childhood Asthma Management Program (CAMP) and six weeks in the Asthma Clinical Research Network (ACRN). (From Tantisira KG, Lake S, Silverman ES, et al. Hum Mol Genet 2004;13[13]: 1353–1359. Reproduced with permission of Oxford University Press.12) Vol. 33 No. 8 • August 2008 • P&T® 455
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