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Zileuton use and phenotypic features in asthma.

P Thalanayar Muthukrishnan1, M Nouraie2, A Parikh3

  • 1Department of Medicine, University of Pittsburgh Medical Center McKeesport, PA, USA.

Pulmonary Pharmacology & Therapeutics
|December 17, 2019
PubMed
Summary

Zileuton response in asthma varies by patient type. Severe asthma and obesity were linked to poorer response rates, suggesting targeted use for non-severe asthma patients.

Keywords:
AsthmaLTE4LeukotrienesLipoxygenaseSevere asthmaZileuton

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Immunology

Background:

  • Zileuton is a 5-lipoxygenase (5LPO) inhibitor impacting the arachidonic acid pathway.
  • It reduces inflammatory leukotriene production, showing potential for complex asthma cases.
  • However, studies indicate only modest response rates in general asthma populations.

Purpose of the Study:

  • To investigate if patient response to zileuton differs across distinct asthma phenotypes.
  • To identify specific asthmatic characteristics associated with varying zileuton efficacy.

Main Methods:

  • Retrospective analysis of 129 asthma patients prescribed zileuton.
  • Detailed lung function and usage data analyzed for 75 patients.
  • Responder status defined by ≥5% annualized increase in post-bronchodilator FEV1%.

Main Results:

  • 28% of patients (21/75) met the responder criteria.
  • Severe asthma was significantly associated with lower response rates (OR 0.12; p=0.004).
  • Obesity showed a trend towards lower response, but did not reach statistical significance (OR 0.46; p=0.15).

Conclusions:

  • Zileuton efficacy varies among asthma patients, with severe asthma and potentially obesity linked to poorer outcomes.
  • Despite current trends, zileuton may be more effective in non-severe asthma.
  • Consideration of zileuton alongside Leukotriene Receptor Antagonists (LTRAs) for non-severe asthma is suggested.