Efficacy Of Leukotriene Receptor Antagonists Research Articles

Comparing the Efficacy of Leukotriene Receptor Antagonists and Intra-nasal Steroids in the Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis

We performed a systematic review and meta-analysis of randomized controlled trials to compare the efficacy of leukotriene receptor antagonists (LTRAs) and intranasal corticosteroids (INCSs) in patients with allergic rhinitis (AR). We searched OVID-MEDLINE (1946 to November 6, 2020), EMBASE, and the Cochrane Library databases for original articles. We used a random-effects model for the meta-analysis to determine the mean difference in the nasal symptom scores between the LTRA and INCS groups. Statistical heterogeneity was assessed using the I2 statistic and chi-squared test. A subgroup analysis was performed using the sample size, treatment duration, and comorbidities. We performed a database search on November 6, 2020, which yielded 922 reports. Of these, five studies were included in the metaanalysis. INCS treatment was more effective than LTRA treatment in relieving the nasal symptom of patients with AR (weighted mean difference [WMD] of the total nasal symptom score change=10.77, 95% confidence interval [CI]: 5.41 to 16.12). The results showed moderate heterogeneity (I2=33%, P=0.20). In the subgroup analysis, the results were homogenous, although some showed heterogeneity and some of the differences between the treatments were not statistically significant. There was moderate heterogeneity in the subgroup analysis (I2=63%, P=0.07), owing to the small sample size (n<600). The results of the study with a long treatment duration (more than 15 days) and those of the studies including patients with asthma were that the difference in the efficacy of INCS treatment and that of LTRA treatment was not statistically significant (WMD=3.86, 95% CI: &#8722;5.8 to 13.52; and WMD=8.18, 95% CI: &#8722;0.29 to 16.65, respectively). Although some of the subgroups showed heterogeneity and did not demonstrate statistically significant differences between the two treatments, the subgroup analysis consistently showed the superiority of INCS in treating patients with AR.

Comparative Study to Assess Clinical Efficacy of Leukotriene Receptor Antagonist and Antihistamines in the Treatment of Allergic Rhinitis

Introduction &#x0D; Pharmacologic treatment options for allergic rhinitis include intranasal corticosteroids, oral and topical antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics and leukotriene receptor antagonists. The present study was undertaken to compare the efficacy of leukotriene receptor antagonist and antihistamines in relieving nasal congestion/ obstruction symptom and itching /irritation in eyes.&#x0D; Material and Methods &#x0D; The study was conducted among 125 patients clinically diagnosed suffering from allergic rhinitis Patients were divided into 5 groups and were given oral treatment with oral antihistamines (chlorpheniramine maleate, levocetrizine, fexofenadine, desloratadine) and leukotriene receptor antagonist (montelukast) for a period of 6 weeks. The results were tabulated and analyzed by Chi-square and Kruskal-Wallis test with p value &lt;0.05 as significant value.&#x0D; Result&#x0D; For relieving nasal obstruction, levocetrizine group showed maximum improvement at 2 weeks. However, at the end of 6 weeks montelukast group showed maximum relief followed by levocetrizine and desloratidine. In relieving eye itching/irritation, montelukast and levocetirizine were equally effective. Fexofenadine and desloratadine were less effective in relieving nasal obstruction and eye itching/irritation followed by chlorpheniramine maleate, which was least effective.&#x0D; Conclusion&#x0D; Allergic rhinitis affects the social and professional life of patient. Allergen avoidance should be the initial step in the management of allergic rhinitis. Montelukast and levocetirizine are more effective in relieving nasal obstruction and eye itching/irritation compared to fexofenadine, desloratadine and chlorpheniramine maleate.

Leukotriene D4inhalation challenge for predicting short-term efficacy of montelukast: a pilot study

The convenient measure to predict efficacy of leukotriene receptor antagonist is lacking. To determine if leukotriene D4 inhalation challenge predicts short-term efficacy of montelukast in asthma. In this open-labelled 28-day trial, 45 patients with asthma were allocated to leukotriene-sensitive and leukotriene-insensitive group to receive montelukast monotherapy (10 mg, once daily) based on the positive threshold of leukotriene D4 inhalation challenge test (4.800 nmol). Miscellaneous measurements comprised fractional exhaled nitric oxide, methacholine inhalation challenge, Asthma Control Test and Asthma Quality of Life Questionnaire. Peak expiratory flow was self-monitored throughout the treatment. End point assessments were performed 3 to 5 days after montelukast withdrawal. Twenty-three patients in leukotriene-sensitive group and 10 leukotriene-insensitive group completed the study. Both groups differed neither in 28-day peak expiratory flow rate nor in maximal weekly peak expiratory flow (both P > 0.05). However, minimal weekly peak expiratory flow was significantly higher in leukotriene-insensitive group throughout the treatment course (all P < 0.05) except for week 1 (P > 0.05). Both groups did not differ statistically in the post-treatment improvement in forced expiratory volume in 1 s (FEV1 ) predicted% prior to inhalation challenge, fractional exhaled nitric oxide or the airway responsiveness to leukotriene D4 or methacholine (all P > 0.05). There was a marked increase in Asthma Control Test score and the symptom score of Asthma Quality of Life Questionnaire in both groups (both P < 0.05). The overall significance of Logistic regression model was unremarkable (P = 0.467). Responsiveness to inhaled leukotriene D4 alone might not be sufficient to predict the short-term efficacy of montelukast monotherapy in patients with asthma.

New efficacy of LTRAs (montelukast sodium): it possibly prevents food-induced abdominal symptoms during oral immunotherapy

BackgroundThe aim of the study was to elucidate whether leukotriene receptor antagonists (LTRAs) can prevent severe allergic reactions, which occur during oral immunotherapy (OIT) in children with food allergies.FindingsFive children with food allergies [3 allergic to hen’s egg (HE), 1 to wheat, and one to cow’s milk (CM); aged between 7 and 12 years; median, 8.5 years] who were started on LTRAs during OIT were retrospectively selected from among 63 children undergoing OIT. In the rush phase, after the administration of the initial dose which was set in open food challenge test, the subsequent doses were increased by approximately 1.2 times of the previous dose and were administered every 2 hours, 4 times a day. The target doses of hen’s egg, wheat (udon noodle), and cow’s milk in the rush phase were 50 g, 200 g, and 200 ml, respectively. The ingestion of the target dose was continued at home every day for at least a year in the maintained phase.Four participants experienced intractable abdominal pain during the rush phase; therefore, the loading dose was not increased in these children. However, the administration of LTRAs prevented their symptoms, resulting in the completion of the rush phase. One participant also experienced intractable abdominal pain during the maintenance phase. After receiving LTRAs, the target dose was able to tolerated.ConclusionThe findings from this retrospective study suggest that the administration of LTRAs is useful for the prevention of adverse allergic reactions such as abdominal pain during OIT.

Efficacy of leukotriene receptor antagonist with anti-H1 receptor antagonist plus anti-H2 receptor antagonist for treatment of refractory chronic idiopathic urticaria

Background: The efficacy of the combination of leukotriene receptor antagonist (LRA) and H1 antihistamine was similar to the synergistic regimen of H1 and H2 antihistamine for treatment of chronic idiopathic urticaria (CIU). However, the effective rates of these two regimens were only 53.3% and 63.3%, respectively.Method: A total of 50 with two combined therapeutic regimens treatment ineffective patients were evaluated. Patients were single blinded and randomly assigned to one of two medication groups that received the following regimens for 4 weeks: Group A (n = 30), combination of LRA, H1 antihistamine and H2 antihistamine. Group B (n = 20) continued with the previously taken two combination regimens. The treatment efficacy was measured by daily urticaria activity score (UAS) of wheal and itch. A positive therapeutic response was defined as a reduction to <25% of baseline weekly UAS, while a relapse was a return to >75% of baseline weekly UAS.Results: At the end of 4 weeks, the UAS response to treatment of Group A was decreased from 35.2% to 21.2%, and the Group B was persisted with 33.9% as before the treatment.Conclusion: The combination of LRA, H2 antihistamine and H1 antihistamine is promising for the refractory CIU cases, which were refractory for two combined therapeutic regimens.

Efficacy of leukotriene receptor antagonist for erosive esophagitis: a preliminary retrospective comparative study

While diagnostic overlap exists between gastroesophageal reflux disease and eosinophilic esophagitis especially on histological findings, therapeutic approaches for the two disease entities are very different. Recently, anti-inflammatory treatment, in addition to acid suppressants, has been investigated for gastroesophageal reflux disease. This study investigated whether the incidence of endoscopic erosive esophagitis was lower in recipients of long-term leukotriene receptor antagonist (LTRA) treatment. This retrospective comparative study included 207 recipients of an LTRA and an equal number of controls who underwent screening upper endoscopic examination. Twenty-two (10.6%) and 51 (24.6%) cases of erosive esophagitis were detected in the LTRA and control groups, respectively (P < 0.001). A significantly higher incidence of minimal change esophagitis was also found in the controls compared with the LTRA group (14.5% vs. 2.4%, P < 0.001). On multivariate analysis, LTRA treatment was significantly and inversely associated with erosive esophagitis (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.13 to 0.46). Within the LTRA treatment group, an increased risk of erosive esophagitis was strongly associated with the presence of hiatal hernia (OR, 5.89; 95% CI, 2.20-15.73, P < 0.001) and short duration of LTRA treatment (OR, 0.64; 95% CI, 0.37-0.89, P= 0.022). In conclusion, this preliminary retrospective analysis demonstrated that patients who underwent long-term treatment with a LTRA had low incidence of endoscopic minimal change esophagitis.

Effects of Leukotriene Receptor Antagonists on Peripheral Eosinophil Counts and Serum IgE Levels in Children with Food Allergy

Background: Although the efficacy of leukotriene receptor antagonists (LTRAs) for bronchial asthma is already established, their effect on food allergy remains unclear. Objective: To investigate the efficacy of LTRAs in children with food allergy. Methods: This retrospective study examined 65 children with food allergy who were aged between 3 and 36 months (mean 14±9.6 months) from 2005 to 2008. Thirty-two children were treated as a dietary control group by avoiding any antigenic foods to which they had previously experienced adverse reactions. The remaining 33 children, designated the LTRA group, were treated with pranlukast (7mg/kg bodyweight/day) in addition to maintaining dietary control. Clinical symptoms and laboratory data before and after 1 year of treatment were compared between the groups. Results: Allergic symptoms improved in both the dietary controlled and LTRA groups, and there was no significant difference observed in the clinical parameters examined between the groups after the 1-year trial. Peripheral eosin-ophil count, serum IgE, interleukin (IL)-4, IL-5, IL-6, and eosinophil cationic protein (ECP) levels in children with food allergy were above standardized values in both groups. Although both the dietary controlled and LTRA groups showed a decreased eosinophil count (−273 ± 232 vs -595 ± 295/μL; p < 0.05 and p < 0.001, respectively), only children treated with LTRA showed a significant decrease in serum IgE (-73.5 ± 115 IU/mL; p < 0.01); conversely, the control group exhibited a significant increase in serum IgE (+159 ± 138 IU/mL; p < 0.01). Furthermore, the LTRA group also showed a significant decrease in serum IL-4 (54.5 ± 31.0 to 27.3 ± 10.1 pg/mL), IL-5 (6.7 ± 5.2 to 5.0 ± 0.4 pg/mL), and ECP (45.4 ± 15.0 to 15.0 ± 9.8 μg/L) levels (p < 0.05 for each). Conclusion: Early intervention with LTRAs may be effective in regulating eosinophil count and serum IgE, IL-4, IL-5, and ECP levels. These data support the potential effectiveness of LTRAs in young children with food allergy to prevent further allergic development.

Effects of Leukotriene Receptor Antagonists on Peripheral Eosinophil Counts and Serum IgE Levels in Children with Food Allergy

Background: Although the efficacy of leukotriene receptor antagonists (LTRAs) for bronchial asthma is already established, their effect on food allergy remains unclear.Objective: To investigate the efficacy of LTRAs in children with food allergy. Methods: This retrospective study examined 65 children with food allergy who were aged between 3 and 36 months (mean 14±9.6 months) from 2005 to 2008. Thirty-two children were treated as a dietary control group by avoiding any antigenic foods to which they had previously experienced adverse reactions. The remaining 33 children, designated the LTRA group, were treated with pranlukast (7mg/kg bodyweight/day) in addition to maintaining dietary control. Clinical symptoms and laboratory data before and after 1 year of treatment were compared between the groups.Results: Allergic symptoms improved in both the dietary controlled and LTRA groups, and there was no significant difference observed in the clinical parameters examined between the groups after the 1-year trial. Peripheral eosin-ophil count, serum IgE, interleukin (IL)-4, IL-5, IL-6, and eosinophil cationic protein (ECP) levels in children with food allergy were above standardized values in both groups. Although both the dietary controlled and LTRA groups showed a decreased eosinophil count (−273 ± 232 vs -595 ± 295/μL; p < 0.05 and p < 0.001, respectively), only children treated with LTRA showed a significant decrease in serum IgE (-73.5 ± 115 IU/mL; p < 0.01); conversely, the control group exhibited a significant increase in serum IgE (+159 ± 138 IU/mL; p < 0.01). Furthermore, the LTRA group also showed a significant decrease in serum IL-4 (54.5 ± 31.0 to 27.3 ± 10.1 pg/mL), IL-5 (6.7 ± 5.2 to 5.0 ± 0.4 pg/mL), and ECP (45.4 ± 15.0 to 15.0 ± 9.8 μg/L) levels (p < 0.05 for each).Conclusion: Early intervention with LTRAs may be effective in regulating eosinophil count and serum IgE, IL-4, IL-5, and ECP levels. These data support the potential effectiveness of LTRAs in young children with food allergy to prevent further allergic development.

Efficacy of leukotriene receptor antagonists and synthesis inhibitors in asthma

Efficacy of leukotriene receptor antagonists and synthesis inhibitors in asthma

Efficacy of leukotriene receptor antagonist with an anti-H1 receptor antagonist for treatment of chronic idiopathic urticaria

Background: Chronic idiopathic urticaria (CIU) is often difficult to treat. Although histamine-releasing activity is detectable for up to 50% of CIU patients, antihistamine therapy provides only a limited response. Objective: This study aimed to assess the clinical efficacy of combined leukotriene receptor antagonist (LRA) and H1 antihistamine, H1 and H2 antihistamine, and two H1 antihistamines as a synergistic therapeutic regimen for treating CIU compared with a matched placebo modality. Methods: A total of 120 newly diagnosed adult patients were evaluated. Patients were single blinded and randomly assigned to one of four medication groups that received the following regimens for 4 weeks: Group A, combination of sedating H1 antihistamine and non-sedating H1 antihistamine; Group B, combination of H1 antihistamine and H2 antihistamine; Group C, combination of H1 antihistamine and LRA; and Group D, matched placebo medication. The primary measure of treatment efficacy was the daily urticaria activity score (UAS) of ‘wheal and itch’. A positive therapeutic response was defined as a reduction to < 25% of baseline weekly UAS, while a relapse was a return to > 75% of baseline weekly UAS. Results: In all, 107 patients completed the trial medication. At the end of 4 weeks, the UAS score as a response to treatment was 23.3% for Group A, 63.3% for Group B, 53.3% for Group C, and no real change for the placebo treatment group. Conclusions: The combination of LRA and H1 receptor antagonist is promising for CIU treatment and is reasonably well tolerated by patients. The combination of H1- and H2-receptor antagonists provided the greatest treatment efficacy by the measures used in this small study.

Efficacy of a Leukotriene Receptor Antagonist in the Treatment of Perennial Allergic Rhinitis

The objectives of this study were to investigate the efficacy of leukotriene receptor antagonists in the treatment of perennial allergic rhinitis. The study was designed as a randomized, 14-day treatment to compare the efficacy of zafirlukast, loratadine, and the combination of loratadine and pseudoephedrine in the treatment of perennial allergic rhinitis. Rhinitis symptom scores, acoustic rhinometry, and rhinomanometry were used to evaluate the efficacy. The results showed that after a 14-day treatment period, patients in all treatment groups had a lower mean score for the symptoms of rhinorrhea, nasal itching, and nasal obstruction (p < .05). Patients who took zafirlukast did not report a significant decrease in sneezing score (p = .1456), but the decrease in nasal obstruction score was more pronounced than in those who took loratadine or loratadine- pseudoephedrine (p = .014). However, the results of acoustic rhinometry and rhinomanometry did not have a significant difference among the three groups (p > .05). The study concluded that zafirlukast seemed to have a better effect on relieving the symptom of nasal obstruction in patients with perennial allergic rhinitis, but the actual mechanism needs further investigation.

Allergic dermatosis and urticaria

Introduction: The management of chronic idiopathic urticaria (CIU) often involves the use of several drug classes to achieve the clinical goal of symptom control. Although the mainstay of treatment remains nonsedating antihistamines, they are often supplemented with H2 receptor antagonists, older generation antihistamines, tricyclic compounds, and, most recently, leukotriene-receptor antagonists (LTRAs). The rationale for use of LTRAs in urticaria is based both on the excellent safety and tolerance profile of this class as well as experimental evidence that LTD4 injection in the skin yields a sustained wheal and flares response even in the setting of antihistamines [1]. Although several studies have examined additive treatment of LTRAs to standard H1 antagonists, the overall clinical experience is ambivalent, possibly due to heterogeneous patient populations. For example, clinical trials with LTRA have shown efficacy in selected CIU populations such as aspirin-sensitive subjects [2] and food additive sensitivity [2], but have not shown global benefit in other CIU subsets [3]. The two recent placebo-controlled, double-blinded studies discussed in this report have provided further insights into the efficacy of LTRAs as montherapy or in combination with desloratadine in the management of CIU.

Leukotriene receptor antagonists in asthma therapy

In persons with asthma, the cysteinyl leukotrienes possess multiple inflammatory properties in vitro and have long been considered to be a potentially important mediator of asthma and an attractive target for therapeutic intervention. Controlled clinical trials have documented the efficacy of leukotriene receptor antagonists in asthma treatment, but reservations about their use for asthma therapy center on two main issues: the heterogeneity of patient responses and their reduced potency relative to other asthma medications. For example, leukotriene receptor antagonists also have been shown to be less efficacious than inhaled corticosteroids for several end points, including symptom relief, reduced markers of inflammation, and improved pulmonary function. This review explores several underappreciated aspects of asthma therapy: heterogeneity of patient responses to medication, the failure of symptoms to correlate with commonly used end points, and the potential of delivery to distal airways for producing important and novel benefits. (J Allergy Clin Immunol 2003;111:S62-70.)

Clinical evidence for antileukotriene therapy in the management of allergic rhinitis

This article presents information summarizing the findings of several clinical trials that evaluated the efficacy and safety of leukotriene receptor antagonists in the treatment of allergic rhinitis. After reading this article, readers will have a greater understanding of these clinical findings and their implications for the management of allergic rhinitis. Relevant and appropriately controlled clinical trials were used. Only literature in the English language was reviewed. Material was taken from academic/scholarly publications, published abstracts, and papers presented at a major congress. Similar to their contribution to the pathogenesis of asthma, cysteinyl leukotrienes have been found to exert potent inflammatory effects in the upper airways and to play a role in the pathogenesis of allergic rhinitis. The guidelines for the diagnosis and treatment of allergic rhinitis emphasize the importance of treating the pathophysiologic pathways of the disease. Thus, the use of antileukotriene therapy is a rational therapeutic option for patients with allergic rhinitis. Findings from several randomized, placebo-controlled clinical trials confirm the efficacy of leukotriene receptor antagonists in reducing the symptoms of allergic rhinitis and improving quality of life. Clinical experience with these medications has also demonstrated their tolerability and safety. Results from recently completed and ongoing clinical trials have expanded the body of evidence for the safety and efficacy of antileukotrienes in the treatment of allergic rhinitis.