Abstract
Anti-leukotrienes, which are competitive antagonists of cysteinyl-leukotriene-1 receptors, are the first new class of anti-asthmatics introduced in over 30 years. There is a strong scientific rationale for their use, as cysteinyl-leukotrienes are increased in asthma and can mimic several of the pathophysiological features of asthma. In addition, there is often increased tissue responsiveness to these mediators. Anti-leukotrienes inhibit several bronchoconstrictor challenges, including allergens, exercise, irritants and aspirin. In clinical trials, they have significant benefit compared with placebo, but are less effective compared with low doses of inhaled corticosteroids. As an add-on therapy to inhaled corticosteroids, they are also disappointing and less effective than long-acting beta(2)-receptor agonists. In clinical practice, they have not proved to be very useful, and they are less cost-effective than other treatments. It is unlikely that this class of drug will be improved greatly in the future, and so will remain as a weak second-line therapy.
Published Version
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