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New Study: Overuse of Combination Drug Therapy in Patients with Mild Asthma Leads to Increased Costs

PHOENIX, Nov. 15, 2010 /PRNewswire-FirstCall/ -- Despite national guidelines recommending that inhaled corticosteroid (ICS) be used alone as the preferred treatment for patients with mild persistent asthma, a new study finds that nearly two-thirds of these patients are taking more costly drugs that combine an ICS and a long-acting beta agonist (LABA) – with no apparent additional clinical benefit noted based on pharmacy and medical claims. The analysis was conducted by the Medco Research Institute™ -- the research subsidiary of Medco Health Solutions, Inc. (NYSE: MHS) – was presented over the weekend during the Annual Scientific Meeting of The American College of Allergy, Asthma & Immunology.



"This study confirms that, based on pharmacy and medical claims, patients with mild asthma using only an inhaled corticosteroid seem to control their asthma just as well as those who take a combined ICS/LABA treatment such as Advair® or Symbicort®," said Luis Salmun, MD, the lead study researcher and National Practice Leader of the Medco Pulmonary/Immunology Therapeutic Resource Center® (TRC).  "While these combination therapies are important treatments for patients with more severe asthma, it's concerning that they are being used by a majority of patients with milder asthmatic symptoms given that these medications are more costly and that clinical guidelines prefer ICS therapy alone for these patients."  

The study evaluated 8,424 patients treated for mild asthma and found that 5,523 were on combined ICS/LABA therapy and 2,901 were using an ICS alone.  Among the two groups of patients there was no significant difference in their use of acute asthma medications, emergency room visits or hospitalizations, indicating that there was no apparent additional clinical benefit gained from using the combined therapy compared to ICS monotherapy.  However, the study did find a difference in costs:  the average asthma-related health care costs for those using the combination ICS/LABA therapy were $264 higher per patient per year than those using the ICS treatment alone.  The study included all combination ICS/LABA drugs, confirming that this is a class effect rather than attributed to a single product.

Findings also revealed that the rate of ICS/LABA combination therapy was highest among patients ages 18 to 49.

In 2010, the Food & Drug Administration (FDA) updated the label on long-acting beta agonists to specify that they should not be used in patients with well-controlled asthma. In patients where a LABA is necessary, once asthma control is achieved and maintained, patients should begin step-down therapy that eliminates the use of long-acting beta agonist while continuing on their ICS treatment.  Lastly, it states that long-acting beta agonists should only be used as additional therapy for patients with uncontrolled asthma currently taking an ICS.

Mild Persistent Asthma

Asthma severity can be classified into one of the following four categories:  intermittent, mild persistent, moderate persistent or severe persistent. Characteristics of a patient classified with mild persistent asthma in this study are:

  • Claims-confirmed diagnosis of asthma and lack of COPD (chronic obstructive pulmonary disease) diagnosis
  • In the previous 12 months:
    • Sporadic use of reliever medications (less than 4 canisters)
    • No exacerbation requiring hospital or ER visits

More details about the analysis and its results can be found at

About Medco Research Institute

Medco Research Institute™ is an evidence-based research organization focused solely on novel research, analytics and new discoveries that close the gap between scientific discovery and medical practice for improved patient outcomes and lower overall healthcare costs. More information about the Medco Research Institute's peer-reviewed research can be found at

About Medco

Medco Health Solutions, Inc. (NYSE: MHS) is pioneering the world's most advanced pharmacy® and its clinical research and innovations are part of Medco making medicine smarter™ for approximately 65 million members.

With more than 20,000 employees dedicated to improving patient health and reducing costs for a wide range of public and private sector clients, and 2009 revenues of nearly $60 billion, Medco ranks 35th on the Fortune 500 list and is named among the world's most innovative, most admired and most trustworthy companies. For more information, go to

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the risks and uncertainties that affect our business, particularly those mentioned in the Risk Factors section of the Company's Annual Report on Form 10-K and Quarterly Reports on Form 10-Q filed with the Securities and Exchange Commission.

SOURCE Medco Health Solutions, Inc.
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