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The Impact of Montelukast Duration on the Risk of Neuropsychiatric Disorders in Children with Asthma: A
Wei-Te Lei1, Chien-Yu Lin2, Szu-Hung Chu1
1Division of Immunology, Rheumatology, and Allergy, Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu 30070, Taiwan.
Insights
Montelukast use in children with asthma generally does not increase neuropsychiatric risks. However, prolonged montelukast use in older children (6-15 years) is linked to a higher risk of Tics/Tourette
Area of Science:
- Pediatric Pulmonology
- Child Neurology
- Pharmacovigilance
Background:
- Asthma is a prevalent childhood chronic illness managed with montelukast.
- Concerns exist regarding montelukast's potential link to neuropsychiatric disorders in children.
Purpose of the Study:
- To investigate the association between montelukast duration and neuropsychiatric risks in pediatric asthma patients.
- To analyze the impact of montelukast treatment duration on specific neuropsychiatric outcomes.
Main Methods:
- A large cohort study utilized Taiwan's National Health Insurance Research Database (NHIRD).
- Propensity score matching was employed to control for confounding factors in asthma patients.
- Neuropsychiatric outcomes, including Tics/Tourette's syndrome, were assessed using Cox proportional hazard models.
Main Results:
- Overall montelukast use did not elevate general neuropsychiatric disorder risk.
- Prolonged montelukast use (>63 days) in children aged 6-15 years significantly increased Tics/Tourette's syndrome risk (2.6x in girls, 1.8x in boys).
- Shorter montelukast use in younger children (0-6 years) correlated with a reduced risk of neuropsychiatric disorders.
Conclusions:
- Montelukast is generally safe regarding neuropsychiatric risks in pediatric asthma.
- Extended montelukast use in older children warrants caution due to potential Tics/Tourette's syndrome association.
- Further research is needed to confirm these findings and guide clinical practice in pediatric asthma management.
Abstract:
Background/Objectives: Asthma is one of the most common chronic diseases in children, and montelukast is widely prescribed to manage symptoms. However, concerns have emerged regarding its potential association with neuropsychiatric disorders. This study aims to investigate the impact of montelukast duration on neuropsychiatric risks in children with asthma. Methods: A cohort study was conducted using Taiwan's National Health Insurance Research Database (NHIRD), including children diagnosed with asthma between 2004 and 2007. A total of 14,606 children in the montelukast cohort and 8432 in the non-montelukast cohort were analyzed, with propensity score matching applied to reduce confounding bias. Neuropsychiatric outcomes, including Tics/Tourette's syndrome, were evaluated using Cox proportional hazard models. Results: Overall, montelukast use did not increase the risk of neuropsychiatric disorders. However, among children aged 6-15 years, prolonged use beyond 63 days was associated with a significantly elevated risk of Tics/Tourette's syndrome, with a 2.6-fold increase observed in girls and a 1.8-fold increase in boys. Conversely, shorter montelukast use in children aged 0-6 years was linked to a lower risk of neuropsychiatric disorders. Conclusions: Although montelukast generally does not elevate neuropsychiatric risks, extended use in older children may increase the likelihood of developing Tics/Tourette's syndrome. These findings highlight the importance of cautious prescribing in pediatric asthma management. Further research is necessary to validate these associations and inform clinical decision making.
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