Montelukast in Hospitalized Patients Diagnosed with COVID-19

Abstract

Background Several therapeutic agents have been assessed for the treatment of COVID-19, but few approaches have been proven efficacious. Because leukotriene receptor antagonists such as montelukast have been shown to reduce both cytokine release and lung inflammation in preclinical models of viral influenza and acute respiratory distress syndrome, we hypothesized that therapy with montelukast would reduce clinical deterioration as measured by the COVID-19 Ordinal Scale.Methods We performed a retrospective analysis of COVID-19 confirmed hospitalized patients treated with or without montelukast. We used “clinical deterioration” as the primary endpoint, a binary outcome defined as any increase in the Ordinal Scale value from Day 1 to Day 3 of hospital stay, as these data were uniformly available for all admitted patients before hospital discharge. Rates of clinical deterioration between the montelukast and non-montelukast groups were compared using the Fisher’s exact test. Univariate logistic regression was also used to assess the association between montelukast use and clinical deterioration.Results A total of 92 patients were analyzed, 30 received montelukast at the discretion of the treating physician and 62 patients who did not receive montelukast. Patients receiving montelukast experienced significantly fewer events of clinical deterioration compared to patients not receiving montelukast (10% vs 32%, p = 0.022). Sensitivity analysis among those without asthma showed a trend toward fewer clinical deterioration events in the montelukast group than non-montelukast groups (11% vs 33%, p = 0.077). Sensitivity analysis among those who did not receive azithromycin showed fewer clinical deterioration events in the montelukast group vs. non-montelukast groups (8% vs 32%, p = 0.030).Conclusions Our findings suggest that montelukast associates with a reduction in clinical deterioration for COVID-19 confirmed patients as measured on the COVID-19 Ordinal Scale. Montelukast may have activity in COVID-19 infection, and future efforts should evaluate this potential therapy.

The roles of lipids in SARS-CoV-2 viral replication and the host immune response

“…CysLT1R blockade decreased airway hyper-responsiveness in mice challenged with RSV (94), and attenuated airway hyper-responsiveness, infiltration of inflammatory cells, and excessive mucus production upon reinfection (95). A retrospective analysis in hospitalized COVID-19 patients reported that the risk of clinical deterioration, defined as any increase in the COVID-19 Ordinal Scale value from day1 to day 3 of hospitalization, was significantly lower in patients treated with montelukast, compared with patients not receiving montelukast (96). Several prospective clinical trials are underway to explore the utility of CysLT1R antagonists in treating COVID-19 (Table ).…”

Asthma and COVID-19: What do we know now

“…In preclinical models of viral influenza and acute respiratory distress syndrome, Montelukast has been shown to decrease both lung inflammation and cytokine release. 47 Montelukast was also shown to reduce eosinophilic inflammation in upper airway inflammatory disease by inhibiting epithelial cell cytokine release and promoting eosinophil survival. 47 Bozek et al found that the rate of Covid-19 infection was significantly lower in a population of elderly patients with severe asthma taking Montelukast, compared to a similar population not taking the drug.…”

“…47 Montelukast was also shown to reduce eosinophilic inflammation in upper airway inflammatory disease by inhibiting epithelial cell cytokine release and promoting eosinophil survival. 47 Bozek et al found that the rate of Covid-19 infection was significantly lower in a population of elderly patients with severe asthma taking Montelukast, compared to a similar population not taking the drug. 42 Of the hospitalized patients with Covid-19, those taking Montelukast, did not need respiratory therapy or multidrug antiviral treatment.…”

“…42 Additionally, Khan et al found that Covid-19 positive patients that were treated with Montelukast experienced significantly fewer events of clinical deterioration that those not receiving the treatment. 47…”

Adjunctive Use of Statins for COVID-19

“…Several therapeutic agents have already been assessed for treating COVID-19, but few of them have been shown to be efficacious [ 4 ]. The lack of treatment options is largely due to limited information on other potential treatments and the lack of multicentre clinical trials evaluating their safety and efficacy [ 5 ].…”