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Montelukast in paediatric asthma and allergic rhinitis: a systematic review and meta-analysis
Karina Mayoral1,2,3,4, Catalina Lizano-Barrantes1,5,6,4, Víctor Zamora1,2,3
1Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain.
Insights
Montelukast effectively controls asthma symptoms in children compared to placebo, but inhaled corticosteroids are more effective, particularly for nighttime symptoms. This systematic review aligns with current asthma treatment guidelines.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Assessing montelukast's impact on pediatric patients with asthma and allergic rhinitis using patient-reported outcomes.
- Comparing montelukast's efficacy against other treatments or placebo.
Approach:
- Systematic review and meta-analysis of 49 studies, primarily randomized clinical trials.
- Searched MEDLINE and Embase databases; data extracted by two independent reviewers.
- Used random-effects model to estimate standardized mean difference (SMD).
Key Points:
- Montelukast showed effectiveness in controlling global asthma symptoms compared to placebo.
- Inhaled corticosteroids (ICS) demonstrated superiority over montelukast for daytime and nighttime asthma symptom control.
- No statistically significant impact of montelukast on health-related quality of life domains was observed.
Conclusions:
- Montelukast is effective for asthma symptom control in pediatric patients versus placebo.
- Inhaled corticosteroids are superior to montelukast for symptom control, especially at night.
- Findings support current asthma management guidelines for children and adolescents.
Background:
We aim to assess the impact of montelukast on paediatric patients with asthma/allergic rhinitis, measured using patient-reported outcome measures, compared with other treatments or placebo.
Methods:
Protocol registration CRD42020216098 (www.crd.york.ac.uk/PROSPERO). MEDLINE and Embase databases were used to conduct the search. Two authors independently selected studies and extracted data, and a third reviewer resolved discrepancies. Meta-analyses were constructed to estimate the standardised mean difference (SMD) using a random-effects model.
Results:
Out of 3937 articles identified, 49 studies met the inclusion criteria, mostly randomised clinical trials (sample sizes: 21-689 patients). The SMD of change pooled estimators for the global, mental and physical domains of health-related quality of life were not statistically significant. For daytime and night-time symptoms scores, the SMD (95% CI) was in favour of inhaled corticosteroids (-0.12, -0.20- -0.05 and -0.23, -0.41- -0.06, respectively). The pooled estimator for global asthma symptoms was better for montelukast when compared with placebo (0.90, 0.44-1.36).
Conclusions:
The synthesis of the available evidence suggests that, in children and adolescents, montelukast was effective in controlling asthma symptoms when compared with placebo, but inhaled corticosteroids were superior in controlling symptoms, especially at night-time. These findings of our systematic review concur with current guidelines for asthma treatment.
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