Acute Effects of Antileukotrienes on Sinonasal Polyposis and Sinusitis

Abstract

Recentl y, leukotrienes have be en imp lica ted in the mediation ofbronchoconstriction and inflanunatory cha nges in asthma. Leukotrien e levels ha ve also been sho wn to be elevated in patients wi th asthma as well as in those with sinonasa l po lyposis and sinus itis. The leukotri ene synthesis inhibito r zileuton and the leu kotri ene recep tor antagonist zafi rlukast have been shown to produce subj ective and objective improvements in patients with m ild to moderate asthma. Given thesefindings, we evaluated the efficacy ofthese two medications in co ntrolling sinonasal polyp osis and their associated sytnptoms. We treated 40 patients dia gn osed with sino nasal polyposis and sinusitis with eithe r zileuton or zafi rlukast. No othe r change lVas made in their standard therapy. Outcome measu res include d subjective int erv iews and qu estionnai re responses, as weil as office endoscop ic exa m ination s and cha rt reviews. A t study's end, 36 patient s lVer e availabl e for evaluation. Tw enty-six had tak en zafi rlukast, five had taken zileuton, andfive othe rs had switched fro m zafi rlukast to zileuton. O verall, 26 pat ients (72 %) exp erience d subj ective iniprovement iil their sytnp tomatology aft er sta rt ing their tnedica tion. Stat istica lly significant imp ro vem ent was not ed with respeet to headach e, fa cial pa in and pressure. ear di scomfort , dentalgia, purulent nasa! discharge, po stna sal drip, na sal congestion and obstru cti on, olfac tio n, and [eve r. An objective allevia tion, or at least stabilization, oj sino nasal polyp osis was see n in 50 % oj the patien ts. Fo urpatient s (11%) discontinued their m edication beca use oj side effects. We co nelude that antileuko trienes niight pl ay a significant role in co ntrolling polyp osis and sym ptoms second-Gl)' to sino nas al disease, and they tnigh t be a viable alternative to long-tertn oral ste roid therapyand rep eated surg ical debridement. From the Oivision of Otolaryngo logy , Albany (N.Y.) Medi cal College .

Leukotriene synthesis inhibitors versus antagonists: The pros and cons

“…LT modifiers are likely to provide benefit in CHES through direct reduction of eosinophil recruitment and activation in the sinuses, and through their ability to diminish eosinophilopoiesis and promote apoptosis. CysLT1 receptor antagonists (zafirlukast and montelukast) have been suggested to have efficacy in CHES/NP in uncontrolled trials [40]. Recently, this group has reported results of a double-blind placebocontrolled trial with montelukast.…”

Refractory chronic rhinosinusitis: pathophysiology and management of chronic rhinosinusitis persisting after endoscopic sinus surgery

“…Leukotriene antagonists have been used for the treatment of nasal polyposis. Reports suggest a beneficial effect [47,48].…”

Pharmacologic management of chronic rhinosinusitis, alone or with nasal polyposis

“…Neither group demonstrated significant improvements in nasal inspiratory flow, no mention was made of changes in polyp size, and the effects were more impressive with respect to asthma than the polyps. A prospective, openlabel study of 36 nasal-polyp patients treated with at least 1 month (mean 7.4 months) of antileukotriene therapy (zafirlukast or zileuton) found that 72% of patients had significant reductions in nasal symptoms, 50% had reduction in polyp size, and 60% of patients no longer required oral steroid therapy [53]. Another study demonstrated a significant reduction in polyp regrowth 3 months after sinus surgery in 18 subjects treated with combination montelukast and fluticasone compared with six controls treated with fluticasone alone [54].…”

“…Another study demonstrated a significant reduction in polyp regrowth 3 months after sinus surgery in 18 subjects treated with combination montelukast and fluticasone compared with six controls treated with fluticasone alone [54]. An ongoing randomized, double-blind, placebo-controlled trial of montelukast after surgical polypectomy may provide greater insight [53]. There is no evidence at present to support the use of antileukotriene therapy in CRS without polyposis.…”