Use of Montelukast in tapering inhaled corticosteroid therapy: an open-label, 48-week trial

Price, David; Rouleau, Michel; Fletcher, C.P.; Patel, Piyush M.; Olivenstein, Ronald; Myhr, Leiv; Virchow, J. C.; Aitchison, W. R. C.; Omenaas, Ernst; Dellea, Pam S.; Laurenzi, Martino; Leff, Jonathan A.

doi:10.1016/s0011-393x(01)80081-3

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…The most commonoccurring side effects are headache and abdominal pain 13 . Montelukast seems to allow effective tapering of inhaled corticosteroid therapy in asthmatic patients 14 …”

Section: Discussionmentioning

confidence: 99%

Severe Erythrodermic Atopic Dermatitis Treated With Montelukast

Broshtilova

Antonov

Bardarov

et al. 2003

Skinmed

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A 26-year-old man presented with a severe, life-long history of atopic dermatitis, with a fluctuating disease course, refractory to conventional therapy such as emollients, topical corticosteroids, oral antihistamines, psoralen UV-A, rifampicin and azathioprine. He had symptoms of nasal congestion and ocular complication of keratoconus, for which corneal transplantation was performed in the previous 2 years. The patient had been treated with depot corticosteroid (betamethasone valerate) for approximately 1 year. Any attempt to discontinue corticosteroid therapy led to new flares; the current relapse had begun 20 days before the time of admission. The physical examination showed exudative erythroderma involving more than 90% of his body surface area with erythematous desquamative plaques, marked lichenification, and evidence of secondary skin infection (Figures 1 and 2). The patient had facial and lower extremity edema and inguinal lymphadenopathy. The blood eosinophilic count (20%) and total serum immunoglobulin E (IgE) (2250 IU) were significantly higher and accompanied by hypoproteinemia (54 g/L) and hypoalbuminemia (25g/L). Systemic corticosteroid therapy of 20-mg methylprednisolone daily was administered to cope with the severe symptoms. As an alternative approach to avoid corticosteroid dependence, 10 days after the beginning of this therapy, the cysteinyl leukotriene receptor antagonist montelukast (10 mg daily) was introduced in an adjunctive manner. The patient's condition improved quickly and gradual reduction of methylprednisolone was undertaken with a step of 4-mg per 5 days, which allowed discontinuation of the corticosteroid for a period of 1 month. At that time the patient's symptoms subsided to several patches involving less than 15% of his body surface area (Figure 3). Montelukast treatment continued for an additional 2 weeks and at the end of the course of treatment a complete remission was achieved (Figure 4). At that time the eosinophils and total IgE level dropped to 15% and 2050 IU, respectively. The patient remained on topical emollient therapy only and at the follow-up visit, 2 months after the end of montelukast treatment, complete remission was sustained. DiscussionThe pathogenesis of atopic dermatitis is not completely understood. Increasing evidence supports the potential role of soluble mediators including leukotrienes in some of the pathogenic variants of the disease. 1,2The leukotrienes are metabolites of the arachidonic acid pathway. Leukotriene synthesis begins with the translocation of activated 5lipoxygenase to the cell membrane, where it forms a complex with a special protein and catalyzes the metabolism of arachidonic acid to 5hydroperoxyeicosatetraenoic acid and subsequently to leukotriene A4 (LTA 4 ), which may be converted to leukotriene B4 (LTB 4 ) or conjugated with glutathione to form leukotriene C4 (LTC 4 ) and their derivatives-leukotriene D4 (LTD 4 ) and leukotriene E4 (LTE 4 ).Cysteinyl leukotrienes (LTC 4 , LTD 4 , LTE 4 ) are potent inflammatory eicosanoids that act...

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“…The most commonoccurring side effects are headache and abdominal pain 13 . Montelukast seems to allow effective tapering of inhaled corticosteroid therapy in asthmatic patients 14 …”

Section: Discussionmentioning

confidence: 99%

Severe Erythrodermic Atopic Dermatitis Treated With Montelukast

Broshtilova

Antonov

Bardarov

et al. 2003

Skinmed

View full text Add to dashboard Cite

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“…Use of montelukast in tapering inhaled corticosteroid therapy: an open‐label, 48‐week trial. Current Therapeutic Research 2001; 62 : 743–55 © by Excerpta Medica Inc [27].…”

Section: The Established Role Of Ltras In Asthmamentioning

confidence: 99%

“…This is considered unlikely, however, as patients who were taking high doses of β agonists (≥100 µg/day) at baseline (i.e. those who were not completely controlled) had their doses of ICS tapered to a similar extent as those taking lower doses (<100 µg/day) [27]. A more logical explanation relates to the complementary anti‐inflammatory activity of LTRAs and ICS.…”

Section: The Established Role Of Ltras In Asthmamentioning

confidence: 99%

“…This concern may be more pronounced in patients with coexisting rhinitis who may also receive nasal steroids, thereby further increasing the steroid load. Data from an open-label, 48-week study in primary care demonstrate that montelukast can allow effective tapering of ICS, without loss of asthma control [27] ( Fig. 1).…”

Section: Tapering Of Inhaled Corticosteroid Therapymentioning

confidence: 99%

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Exploring the role of leukotriene receptor antagonists in the management of allergic rhinitis and comorbid asthma

Pawankar

2003

Clin Exp All Rev

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Summary The links between asthma and rhinitis are well documented and are based upon epidemiological, immunological and clinical observations. Leukotriene receptor antagonists (e.g. montelukast) are an established, effective and well tolerated treatment option for asthma, and more recent evidence now demonstrates their clinical utility in the treatment of allergic rhinitis. In seasonal allergic rhinitis, montelukast monotherapy has been shown to provide relief from daytime nasal symptoms (including congestion, runny nose, nasal itching and sneezing), as well as nighttime and eye symptoms. These clinical benefits were associated with reduced eosinophil counts in the blood, suggesting an effect on the underlying mechanisms of allergic inflammation. In addition, studies that have evaluated the combination of an antileukotriene with an antihistamine have typically shown a numerical and sometimes statistical benefit of combination therapy. Given the frequent coexistence and shared pathophysiologies of asthma and allergic rhinitis, a common therapeutic approach would seem warranted. Leukotriene receptor antagonists, such as montelukast, are emerging as a rational approach to ‘one airway’ disease management.

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“…4,5 Although neither montelukast nor zafirlukast is licensed for steroid sparing (i.e. minimising the dose of inhaled steroid), Lofdahl et al, 32 Price et al 33 and Riccioni et al 34 have reported some evidence that this may be possible.…”

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confidence: 99%

A pragmatic single-blind randomised controlled trial and economic evaluation of the use of leukotriene receptor antagonists in primary care at steps 2 and 3 of the national asthma guidelines (ELEVATE study).

Price

Musgrave²,

Wilson³

et al. 2011

Health Technol Assess

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Use of Montelukast in tapering inhaled corticosteroid therapy: an open-label, 48-week trial

Cited by 8 publications

References 19 publications

Severe Erythrodermic Atopic Dermatitis Treated With Montelukast

Severe Erythrodermic Atopic Dermatitis Treated With Montelukast

Exploring the role of leukotriene receptor antagonists in the management of allergic rhinitis and comorbid asthma

A pragmatic single-blind randomised controlled trial and economic evaluation of the use of leukotriene receptor antagonists in primary care at steps 2 and 3 of the national asthma guidelines (ELEVATE study).

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