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A proof of concept study to evaluate putative benefits of montelukast in moderate persistent asthmatics
Author(s) -
Currie Graeme P.,
Lee Daniel K. C.,
Dempsey Owen J.,
Fowler Stephen J.,
Cowan Louise M.,
Lipworth Brian J.
Publication year - 2003
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1046/j.1365-2125.2003.01813.x
Subject(s) - montelukast , methacholine , salmeterol , placebo , medicine , crossover study , salbutamol , asthma , anesthesia , respiratory disease , lung , alternative medicine , pathology
Aims Whether chronic dosing with montelukast confers benefit in patients with moderate to severe asthma remains to be fully established. A proof of concept study was performed evaluating putative benefits with montelukast in moderate persistent asthmatics who were taken off inhaled corticosteroids (ICS) and switched to salmeterol. The latter was done to dissociate the effects of montelukast from ICS. Methods Twenty moderate to severe persistent asthmatics completed a randomized double‐blind crossover study. Subjects received montelukast 10 mg daily or placebo for 2 weeks each. This was preceded by a 2‐week run‐in when ICS were discontinued and salmeterol started, and used on a regular basis throughout the study. Measurements were made after run‐in and after both randomized treatments. Results There were no significant sequence effects for responses as to whether placebo or montelukast were given first or second. Methacholine P D 20 values after run‐in, first and second placebo were 63 µg, 60 µg and 64 µg, respectively (corresponding to 2, 4 and 6 weeks of ICS washout, respectively). Lung function deteriorated pre vs post run‐in, which was significant ( P < 0.05) for FEF 25‐75 % predicted. Montelukast conferred significant ( P < 0.05) improvements as change from post run‐in compared with placebo in methacholine P D 20 , FEV 1 % predicted, FEF 25‐75 % predicted, diurnal peak expiratory flow, symptoms and salbutamol use. For the primary outcome of methacholine PD 20 , this amounted to a 1.6‐fold difference (95% CI 1.1, 2.5). Conclusions In moderate persistent asthmatics switched from taking ICS to salmeterol alone, adding montelukast conferred significant benefits on all parameters of asthma control. Further studies are indicated to evaluate whether montelukast exhibits additive effects to ICS/long‐acting β 2 ‐adrenoceptor agonist combination inhalers upon clinically important outcomes.