Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma

Chauhan, Bhupendrasinh F; Jeyaraman, Maya M.; Mann, Amrinder Singh; Lys, Justin; Abou‐Setta, Ahmed M; Zarychanski, Ryan; Ducharme, Francine M

doi:10.1002/14651858.cd010347.pub2

Cited by 24 publications

(10 citation statements)

References 76 publications

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“…A random number table was used to generate sequence. Odd numbers were allocated to treatment group, even numbers were allocated to control group.Chauhan et al [14]1 (2.7%)Participants were randomised to 2 groups according to their order of presentation at the outpatient clinic.McCaughan et al [15]1 (16.7%)The randomisation protocol was compromised by selecting patients serially as they registered.Menting et al [8]2 (6.9%)Czibik-stable 2008 and Czibik-unstable 2008: “Randomisation not reported”…”

Section: Resultsmentioning

confidence: 99%

Risk of bias assessment of sequence generation: a study of 100 systematic reviews of trials

et al. 2019

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BackgroundSystematic reviews of randomised trials guide policy and healthcare decisions. Yet, we observed that some reviews judge randomised trials as high or unclear risk of bias (ROB) for sequence generation, potentially introducing bias. However, to date, the extent of this issue has not been well examined. We evaluated the consistency in the ROB assessment for sequence generation of randomised trials in Cochrane and non-Cochrane reviews, and explored the reviewers’ judgement of the quality of evidence for the related outcomes.MethodsCochrane intervention reviews (01/01/2017–31/03/2017) were retrieved from the Cochrane Database of Systematic Reviews. We also searched for systematic reviews in ten general medical journals with highest impact factors (01/01/2016–31/03/2017). We examined the proportion of reviews that rated the sequence generation domain as high, low or unclear risk of selection bias. For reviews that had rated any randomised trials as high or unclear risk of bias, we examined the proportion that had assessed the quality of evidence.ResultsOverall, 100 systematic reviews were included in our analysis. We evaluated 64 Cochrane reviews which comprised of 984 randomised trials; 0.8% (n = 8) and 52.2% (n = 514) were rated as high and unclear ROB for sequence generation respectively. We further evaluated 36 non-Cochrane reviews which comprised of 1376 trials; 5.8% (n = 80) and 39.6% (n = 545) were rated as high and unclear ROB respectively. Ninety percent (n = 10) of non-Cochrane reviews which rated randomised trials as high ROB for sequence generation did not report an underlying reason. All Cochrane reviews assessed the quality of evidence (GRADE). For the non-Cochrane reviews, only just over half had assessed the quality of evidence.ConclusionSystematic reviews of interventions frequently rate randomised trials as high or unclear ROB for sequence generation. In general, Cochrane reviews were more transparent than non-Cochrane reviews in ROB and quality of evidence assessment. The scientific community should more strongly promote consistent ROB assessment for sequence generation to minimise selection bias and support transparent quality of evidence assessment. Consistency ensures that appropriate conclusions are drawn from the data.

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Section: Resultsmentioning

confidence: 99%

Risk of bias assessment of sequence generation: a study of 100 systematic reviews of trials

et al. 2019

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“…Leukotriene receptor antagonists inhibit the pro-inflammatory effect of leukotrienes not completely suppressed by corticosteroid therapy. The addition of LTRA to symptomatic adult asthmatics already treated with regular ICS monotherapy leads to reduced exacerbations, better asthma control and better lung function ( 58 , 59 ).…”

Section: Guideline Recommended Approach For Chronic Asthmamentioning

confidence: 99%

“…It is unclear if LTRA is superior to higher doses of ICS monotherapy ( 58 ) except in adults with aspirin-intolerant asthma. However, asthma symptoms, lung function, and rescue medication use are improved when LTRA is added to high doses of ICS ( 60 ).…”

Section: Guideline Recommended Approach For Chronic Asthmamentioning

confidence: 99%

Two Sides of the Same Coin?—Treatment of Chronic Asthma in Children and Adults

Chung¹,

Paton²

2019

Front. Pediatr.

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Globally, asthma is one of the most common chronic conditions that affect individuals of all ages. When poorly controlled, it negatively impacts patient's ability to enjoy life and work. At the population level, effective use of recommended strategies in children and adults can reduce symptom burden, improve quality of life and significantly reduce the risk of exacerbation, decline of lung function and asthma-related death. Inhaled corticosteroid as the initial maintenance therapy, ideally started within 2 years of symptom onset, is highly effective in both children and adults and across various degrees of asthma severity. If asthma is not controlled, the choice of subsequent add-on therapies differs between children and adults. Evidence supporting pharmacological approach to asthma management, especially for those with more severe disease, is more robust in adults compared to children. This is, in part, due to various challenges in the diagnosis of asthma, in the recruitment into clinical trials and in the lack of objective outcomes in children, especially those in the preschool age group. Nevertheless, where evidence is emerging for younger children, it seems to mirror the observations in adults. Clinicians need to develop strategies to implement guideline-based recommendations while taking into consideration individual variations in asthma clinical phenotypes, pathophysiology and treatment responses at different ages.

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“…Understanding if gender is a key predictor for anti-leukotriene treatment' effectiveness is pivotal considering the jeopardization of asthmatic patients that benefit from leukotriene receptor antagonist, whose population, to date, it is not well characterized (Helms, 2000 ; Borish, 2002 ; Nayak, 2004 ; Chauhan et al, 2013 , 2017 ; Bush, 2015 ; Cingi et al, 2015 ; Marcello and Carlo, 2016 ; Pyasi et al, 2016 ). Moreover, providing new evidence for gender differences in asthma' treatment is needed considering that clinical studies investigating aforementioned associations are missing (Pignataro et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Gender and the Effectiveness of Montelukast: An Italian/Danish Register-Based Retrospective Cohort Study

et al. 2018

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Rationale: Gender-related differences in asthma prevalence, pathophysiology and clinical features induced by sex steroids have been investigated, however, how gender influences response to asthma treatments in routine clinical practice have not yet been elucidated fully. This aspect is crucial for montelukast considering the jeopardization of asthmatic patients that benefit from this treatment and the existence of evidence of gender differences in leukotriene levels. Therefore, to fulfill this medical need, we investigated the role of gender on a set of montelukast' effectiveness surrogates in adults and pediatric patients with asthma.Methods: The study settings were Napoli 2 Local Health Unit (southern Italy) and the entire Danish territory. The study population was composed of adult and pediatric patients with asthma. Cumulative incidence curves, unadjusted and adjusted Cox regression were used as statistical models to compare aforementioned outcomes between genders.Results: Adult Italian male users of montelukast had a statistically lower persistence in montelukast treatment compared to female users. In the adjusted analyses, they had a higher hazard of montelukast' withdrawal (Hazard Ratio [HR] 1.07; 95% Confidence Interval [CI] 1.01–1.14), add-on/switch to a long-term treatment for asthma following montelukast withdrawal (HR 1.72; 95%CI 1.39–2.12), and rescue therapy with short-acting β2 agonist (HR 1.24; 95%CI 1.04–1.47). In the adult Danish cohort, we also found that male users had higher a hazard of rescue therapy with oral corticosteroids (HR 1.10; 95%CI 1.04–1.16). In the pediatric cohorts, no statistically significant differences were observed between genders for aforementioned outcomes.Conclusions: In adults, male gender was associated with increased hazards of montelukast discontinuation, add-on/switch to a long-term treatment for asthma following montelukast withdrawal, and rescue therapy with oral corticosteroids or short-acting β2 agonist when compared to the female gender. As expected, these associations were reversed or absent in pediatric patients.

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Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma

Cited by 24 publications

References 76 publications

Risk of bias assessment of sequence generation: a study of 100 systematic reviews of trials

Risk of bias assessment of sequence generation: a study of 100 systematic reviews of trials

Two Sides of the Same Coin?—Treatment of Chronic Asthma in Children and Adults

Relationship Between Gender and the Effectiveness of Montelukast: An Italian/Danish Register-Based Retrospective Cohort Study

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