Clinical efficacy of cysteinyl leukotriene receptor antagonism in nasal polyposis: Relationship to systemic action on eosinophils?

Abstract

Rationale The aim of this study was to determine if the antileukotriene, montelukast, could benefit nasal polyposis, a chronic eosinophilic inflammatory condition. Methods 23 adults with bilateral nasal polyps were randomized in a double-blind, placebo-controlled, cross-over study to compare 4 weeks of once daily treatment with 10 mg montelukast or placebo. There was a 4 week washout period between treatments. Subjects remained off intranasal steroids for at least 4 weeks prior to treatment. A global assessment was completed at the end of each treatment period where a maximal score of 3 was equivalent to “very much better”. Nasal peak inspiratory flow (NPIF) was measured twice daily. A disease specific nasal polyposis quality of life questionnaire was completed before and after each treatment period. Blood eosinophils and in a subset, blood eosinophil progenitors, were measured before and after each treatment. Results There was a significant improvement by global assessment with montelukast treatment compared to placebo (overall mean 1.6 vs −0.2, p=0.001). Quality of life was significantly better with active treatment compared to placebo (mean improvement of 0.6 vs 0.1, p=0.01). NPIF improved significantly with treatment (mean change −8.2 vs 1.3 L/min, p=0.01). There was a trend towards a reduction in blood eosinophils (p=0.07) accompanied by a persistence of eosinophil progenitors in the circulation with treatment Conclusions Cysteinyl leukotriene receptor antagonism has both a local and systemic beneficial effect in nasal polyposis.