Nizankowska et al., "Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist
: a randomized, double-blind, placebocontrolled trial," American Journal of Respiratory and Critical Care Medicine, vol.
Data Source: Two parallel, multicenter "pragmatic" trials to assess the real-world effectiveness of leukotriene antagonists
compared with inhaled glucocorticoids as first-line treatment and compared with long-acting beta-agonists as add-on therapy for poorly controlled asthma.
Less evidence supports the use of leukotriene antagonists
and inhaled corticosteroids, either individually or in combination (SOR: B).
[D] Do not commence leukotriene antagonists
Drugs called leukotriene antagonists
, which are taken orally, are often more useful than inhalers for this type of asthma.
Two second prizes (a tie) were awarded to Angela Naismith (Leukotriene Antagonists
) and Craig Jeffrey, MCIC (Photonic Band Gap Materials).
The increasing understanding of leukotriene involvement in inflammation has resulted in the design of new types of anti-inflammatory medications for asthma: leukotriene antagonists
Omalizumab was evaluated in a pivotal 52-week study of 627 children aged 6-11 years with moderate to severe persistent, inadequately controlled allergic asthma, despite treatment with fluticasone at a dose of 200 mcg or more per day (or the equivalent), with or without other controller medications, which included short-acting beta-agonists (a mean of 2,8 puffs/day) and leukotriene antagonists
Studies have found that patients never refill 40%-70% of prescriptions for leukotriene antagonists
, long-acting [[beta].sub.2]-agonists, and inhaled corticosteroids.
Mediators other than histamine, including leukotrienes, are involved in the wheal-and-flare urticarial response, so one of the leukotriene antagonists
used in asthma may be of benefit.
Further research comparing inhaled corticosteroids with leukotriene antagonists
also would be beneficial in supporting the use of leukotriene antagonists
as either alternative or add-on therapy in the treatment of chronic asthma.
(1,2) Additional features of the leukotriene antagonists
are that they are given orally, thus avoiding any potential patient adherence problems with the use of inhaler devices, but also providing systemic activity and hence suppressing inflammation throughout the airway, including inflammation in the smaller airways.