SMART Therapy - Asthma
Be SMART with Asthma
Have you heard of SMART Therapy?
SMART Therapy stands for Single Maintenance and Reliever Therapy and currently recommended for patients four years of age and older with moderate to severe asthma. The treatment involves the use of one inhaler that includes an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA), specifically formoterol, for both maintenance and reliever therapy.
ICS-LABA (formoterol) Combinations on the Market |
Notes |
---|---|
Symbicort®™ (budesonide/formoterol) |
Preferred for SMART Therapy; extensively studied |
Dulera®™ (mometasone/formoterol) |
Not currently studied |
According to the Asthma Management Guidelines updated in 2020 by the National Heart, Lung, and Blood Institute (NHLBI), patients on daily ICS-LABA treatment, plus uncontrolled short-acting beta agonist (SABA), as needed, may also benefit from SMART therapy. Evidence supports switching to SMART Therapy at the same or lower maintenance ICS-LABA dose before considering a step up in maintenance treatment. If patients are well-controlled on the ICS-LABA plus SABA treatment, SMART Therapy may offer less added benefit; thus, the regimen should be maintained. Additionally, the Global Initiative for Asthma (GINA) guidelines were updated in December 2022 to include the use of SMART Therapy in moderate to severe asthma management.
Clinical Trial |
Drugs Studied |
Test Population |
Results |
Key Takeaways |
---|---|---|---|---|
SYGMA (Symbicort Given As Needed in Mild Asthma) |
SYGMA 1 |
Adult patients with mild asthma and patients with moderate to severe asthma |
* prn budesonide/formoterol was associated with significantly lower severe exacerbation rate (26% reduction) compared to budesonide maintenance in patients previously receiving only prn SABA in both SYGMA 1 and 2 |
Adults may be better protected by switching to prn ICS/formoterol vs prn SABA |
Novel START (Novel Symbicort Turbuhaler Asthma Reliever Therapy) |
albuterol 100mcg two puffs prn |
Adult patients with mild asthma |
* budesonide/formoterol prn was superior to albuterol prn for prevention of asthma exacerbations with a 60% reduction in severe exacerbations |
ICS/formoterol was superior to albuterol when used as needed for asthma exacerbations |
MANDALA |
albuterol 180mcg/budesonide 160mcg |
Based on the current evidence and continued studies, the decrease in medication burden and reduction in medication costs for patients with asthma are clinically significant, utilizing SMART Therapy.
Important Points for All Clinicians:
- Traditional asthma management uses different medications for maintenance and reliever therapy, whereas, SMART Therapy uses the same medication for BOTH!
- SMART Therapy may reduce the risk of confusion on which inhaler to use for maintenance or reliever for patients, especially children.
- SMART Therapy is part of the National Asthma Education and Prevention Program (NAEPP) and is detailed in the 2020 NHLBI and 2022 GINA guidelines.
- SMART Therapy is not currently FDA approved for mild asthma.
- In relation to the Asthma Medication Ratio (AMR) HEDIS measure, low dose ICS/LABA (formoterol) combinations are considered ‘Asthma Controller Medications’ and, when filled, lead to a higher percentage of ‘Asthma Controller Medications’ over ‘Total Asthma Medications’. This results in a higher AMR compliance rate; thus, the use of only one inhaler for those with moderate to severe asthma may enhance patient compliance while potentially decreasing exacerbations and lowering costs simultaneously.
RESOURCES:
- Allergy Asthma Network – Asthma-smart-therapy
- Community AAFA Org
- Allergy Asthma Network – Mandala Study
- Pocket Guide WMS
- ATS Journals
- Pub Med
- SPBM Medicaid
- SPBM Medicaid – Unified Preferred Drug List
- SPBM Medicaid – Quantity Limits