Levalbuterol no more efficacious than racemic albuterol in treatment of pediatric asthma

Children suffering from acute exacerbation of asthma can expect levalbuterol (Xopenex, Sepracor) (LEV) to produce results that are no better-yet are more costly-than racemic albuterol (RAC), according to a study published in Pediatric Emergency Care.

All patients in the prospective, double-blind, randomized research trial showed improvement in oxygen saturations, respiratory rates, and peak flow rates. However, no statistically significant difference was observed in the 2 drug groups regarding the respiratory parameters (P>.05).

RAC-an equal mixture of 2 isomers, R-albuterol and S-albuterol-has been the agonist most commonly prescribed to treat asthma. In recent years, LEV has been touted as an alternative with better efficacy because of the absence of the negative side effects of S-albuterol.

Baseline respiratory parameters such as oxygen saturations, respiratory rates, and peak flow rates were measured and repeated after every treatment. The decision for additional treatments and/or hospitalization was made by the treating emergency department physician as per his or her clinical judgment of the respiratory parameters at the end of 3 treatments.

Among the 34 patients who received RAC, 7 (10%) required extra treatments and 2 (2.9%) were admitted. Among the 36 who received LEV, 5 (7.1%) required extra treatments and 3 (4.3%) were admitted. Applying the chi square and the Fisher exact test, no statistically significant differences for the need for extra treatments and admission were observed.

LEV, in addition to faring no better than RAC in efficacy, costs far more; 100 doses of LEV cost $198 compared with $33 for RAC.

"Hence, if clinical practice is to change, LEV should be more efficacious and result in being cost-effective," the authors stated.

The authors warned of some study limitations, starting with the small number of patients. In addition, they used outcomes such as oxygen saturations, respiratory rate, and peak flow rate, which are good objective measures but are not the most common measures that physicians choose to assess disease in asthma patients.

SOURCE Hardasmalani MD, DeBari V, Bithoney WG, Gold N. Levalbuterol versus racemic albuterol in the treatment of acute exacerbation of asthma in children. Pediatr Emerg Care. 2005; 21:415–419.