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Race determined response to step-up therapies in children with asthma, eczema

Children with asthma without a history of eczema responded best to long-acting B-agonist step-up therapy, while those with asthma and eczema had different responses based on race, according to study results.

Researchers conducted a post-hoc analysis of 163 children, aged 6 to 17 years, with uncontrolled asthma on 100 mg fluticasone twice daily at baseline. Eighty-five children (43.7% male) had a history of eczema, while 78 children (46.6% male) did not.

In a masked, triple crossover design, patients randomly received step-up therapies for 16 weeks: 250 mcg fluticasone twice daily (low dose inhaled corticosteroids [ICS]), 100 mcg fluticasone plus 50 mcg salmeterol twice daily (long-acting B-agonist [LABA]), and 100 mcg fluticasone twice daily plus 5 mg or 10 mg montelukast daily (leukotriene receptor antagonist [LTRA]).

Differential response to the treatments was experienced by 98% of patients.

LABA treatment was 1.5 times more likely to provide the best response compared with the other treatments for all patients.

“There was a strong pattern of best responses to LABA step-up in children without a history of eczema regardless of race or ethnicity status,” the researchers reported.

Preferred responses to therapy depended on race/ethnicity (P=.0002) in patients with a history of eczema. Black participants (n=29) in the eczema cohort responded best to ICS step-up, while white Hispanics (n=19) responded best to LTRA. White non-Hispanics (n=31) in the eczema cohort had equivalent responses to step-up LTRA or LABA therapies.

“If validated, these novel findings might provide a personalized approach in targeting interventions for children with uncontrolled asthma based on specific and easily obtainable clinical features such as a history of eczema and race/ethnicity,” the investigators wrote.

Disclosure: See the study for a full list of relevant financial disclosures.