Adverse drug reactions of leukotriene receptor antagonists in children with asthma: a systematic review

Dixon, Eleanor; Rugg-Gunn, Charlotte E. M.; Sellick, Vanessa; Sinha, Ian; Hawcutt, Daniel B

doi:10.1136/bmjpo-2021-001206

Cited by 21 publications

(14 citation statements)

References 29 publications

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“…21 22 Since then, further concerns regarding the adverse drug reactions attributed to montelukast in CYP with asthma have been outlined in a recent PROSPERO systematic review. 23 …”

Section: Discussionmentioning

confidence: 99%

Deprescribing montelukast in children with asthma: a systematic review

et al. 2022

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BackgroundNational and international asthma guidelines recommend adjusting asthma treatment based on levels of control, yet no guidance is given regarding the stepping-down of montelukast in children and young people (CYP).ObjectiveTo systematically review evidence regarding deprescribing montelukast in CYP with established asthma.DesignSystematic review.Data sourcesEmbase, Medline, PubMed and CINAHL were searched up to October 2020.Study selectionEligible studies contained patients aged 0–18 years with a diagnosis of asthma, who had been administering montelukast before it was withdrawn. All reasons for withdrawal were included.ResultsThe search identified 197 papers. After deduplication, five papers were included (three randomised control studies and two cohort studies). Four studies observed the impact of montelukast withdrawal for 2 weeks, and one study for 8 weeks. The impact of withdrawal was measured in the studies using a combination of lung tests (eg, forced expiratory volume in 1 s (FEV1), fractional exhaled nitric oxide (FeNO)), asthma scoring methods and exercise challenges. Of the 17 domains in the Core Outcome Set for Clinical Trials in Childhood Asthma, eight outcomes were measured in at least one of the five studies, with all five studies measuring the outcome of ‘Lung Function’. No significant differences were found between the montelukast and placebo groups following montelukast withdrawal. Significant differences between the comparator points within the test group were found in nine outcomes across four studies; FEV1/forced vital capacity, FEV1, forced expiratory flows (25%–75%), asthma score (study specific), maximum % fall in FEV1 and time to recovery (post exercise) significantly decreased whereas FEV1/bronchodilator response, FeNO and eNO significantly increased.ConclusionOnly limited, contradictory and short-term effects of deprescribing montelukast in CYP with established asthma are presented in literature. Definitive studies determining clinical stability, and impact of deprescribing montelukast in CYP are imperative to improve the safety of asthma treatment in CYP.PROSPERO registration numberCRD42020213971.

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“…21 22 Since then, further concerns regarding the adverse drug reactions attributed to montelukast in CYP with asthma have been outlined in a recent PROSPERO systematic review. 23 …”

Section: Discussionmentioning

confidence: 99%

Deprescribing montelukast in children with asthma: a systematic review

et al. 2022

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“…They remarked that the side effects associated with LTRAs are predominantly gastrointestinal and neuropsychiatric disorders. 18 In the literature, there are few cases of montelukast-associated hallucinations. [19][20][21] In 2015, Erdem et al 21 reported 4 hallucinations in 1024 cases.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Adverse drug reactions affecting treatment adherence in first-line treatment of asthma: An observational study

Erdem

Nacaroğlu²,

Can³

2023

Allergol Immunopathol

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Background: Asthma is the most common chronic lung disease among children. International guidelines recommend inhaled corticosteroids (ICS) as the first-line daily controller therapy for children with asthma and leukotriene receptor antagonists (LTRA) as the second alternative therapy. Adherence to treatment is the most significant component to optimize the benefits of therapy in asthma. Objective: This study aims to investigate the frequency of drug discontinuation due to adverse drug reactions (ADRs) that affect adherence to treatment in children with asthma or asthma and allergic rhinitis using LTRA or ICS as monotherapy. Methods: The subjects aged 4–18 years with asthma or asthma and allergic rhinitis and using montelukast or ICS as monotherapy were included in the study. They were evaluated in terms of ADRs affecting adherence to treatment in the first and third months of treatment. Results: A total of 468 cases, 356 of whom received montelukast monotherapy and 112 of whom received ICS treatment, with a mean age of 9.10 ± 3.08 (4–17) years, were included in the study. Males constituted 65.6% of the total cases (n = 307). In the first month of follow-up of the cases, it was observed that 4.8% (n = 17) of the patients in the montelukast group could not continue the treatment due to ADR. It was determined that the drug discontinuation rate in the montelukast group in the first month was significantly higher than in the ICS group (P = 0.016), and the risk of drug discontinuation due to ADR in the montelukast group was 1.333 (95% CI, 1.26–1.40) times higher. Conclusions: As a result, it was observed that the drug was discontinued due to ADR at a higher rate in children with asthma who received montelukast monotherapy compared to those who received ICS monotherapy.

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“…Przyjmowanie leków przeciwleukotrienowych może skutkować występowaniem łagodnych działań niepożądanych, natomiast poważniejsze działania niepożądane występują u bardzo niewielkiego odsetka pacjentów (Tabela 10). Wobec tego terapia z wykorzystaniem LTRA jest bezpieczna zarówno u dorosłych i u dzieci [33,42,45,157,158]. W ostatnim czasie pojawiły się doniesienia na temat dużo wyższego niż dotąd sądzono przenikania LTRA, zwłaszcza montelukatu, przez barierę krew-mózg, [158].…”

Section: Działania Niepożądane Leków Przeciwleukotrienowychunclassified

“…Wobec tego terapia z wykorzystaniem LTRA jest bezpieczna zarówno u dorosłych i u dzieci [33,42,45,157,158]. W ostatnim czasie pojawiły się doniesienia na temat dużo wyższego niż dotąd sądzono przenikania LTRA, zwłaszcza montelukatu, przez barierę krew-mózg, [158]. Fakt ten wiąże stosowanie montelukastu z zaburzeniami psychiatrycznymi prowadzącymi do myśli samobójczych oraz zespołem Churga-Straussa (przewlekłym alergicznym zapaleniem naczyń krwionośnych) [95,150,158,159].…”

Section: Działania Niepożądane Leków Przeciwleukotrienowychunclassified

“…W ostatnim czasie pojawiły się doniesienia na temat dużo wyższego niż dotąd sądzono przenikania LTRA, zwłaszcza montelukatu, przez barierę krew-mózg, [158]. Fakt ten wiąże stosowanie montelukastu z zaburzeniami psychiatrycznymi prowadzącymi do myśli samobójczych oraz zespołem Churga-Straussa (przewlekłym alergicznym zapaleniem naczyń krwionośnych) [95,150,158,159]. Związek terapii montelukastem z występowaniem tych jednostek chorobowych wymaga przeprowadzania dodatkowych badań klinicznych.…”

Section: Działania Niepożądane Leków Przeciwleukotrienowychunclassified

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Anti-leukotriene drugs in the therapy of inflammatory diseases

Karolina¹,

Pisklak²

2022

pps

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A key part of many chronic diseases is inflammation controlled by inflammatory mediators. Regulation of their function allows to mute the inflammatory response, which is a desired effect in the treatment of inflammatory diseases. The source of mediators is arachidonic acid, converted to pro-inflammatory mediators by cyclooxygenases (COX) or lipooxygenases (LOX). The 5-LOX pathway is full of target points for regulation of biosynthesis of cysteinyl leukotrienes (CysLT) – one of the major classes of inflammatory mediators. These compounds exert their activity through specific leukotriene receptors – first (CysLT1R) and second (CysLT2R). Drugs that inhibit CysLT synthesis as well as leukotriene receptors antagonists (LTRA) form group of drugs known as anti-leukotriene drugs. Currently, only a few representatives of this group are available in the pharmacies around the world: the 5-LOX inhibitor – zileuton – and three CysLT1R antagonists – montelukast, pranlukast, zafirlukast. LTRAs due to their wide range of anti-inflammatory effects, are a group of drugs with a high potential in the treatment of inflammatory diseases. The study of new applications of known LTRAs and the search for new members of the LTRA group are the main directions of development in this field of pharmacy. This work summarizes the benefits of using anti-leukotriene drugs in the treatment od chronic diseases and presents new directions of using LTRAs.

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Adverse drug reactions of leukotriene receptor antagonists in children with asthma: a systematic review

Cited by 21 publications

References 29 publications

Deprescribing montelukast in children with asthma: a systematic review

Deprescribing montelukast in children with asthma: a systematic review

Adverse drug reactions affecting treatment adherence in first-line treatment of asthma: An observational study

Anti-leukotriene drugs in the therapy of inflammatory diseases

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