Montelukast use over the past 20 years: monitoring of its effects and safety issues

Abstract

Montelukast, a leukotriene receptor antagonist, was launched 20 years ago in Korea. It is recommended as an alternative treatment for asthma in children with mild persistent symptoms or as an add-on treatment to existing low-dose inhaled corticosteroids (ICSs) in children who require additional treatment. However, in the real-world setting, many doctors and patients prefer montelukast over ICSs despite their lower efficacy. Although montelukast is considered to be a safe drug, there are concerns regarding adverse drug reactions, including the rare occurrence of Churg-Strauss syndrome and, despite insufficient data, the possibility of neuropsychiatric events such as anxiety, depression, sleep disturbance, and suicidality. This review identified that montelukast has significantly contributed to asthma control over the past 20 years in Korea and has been critical for reducing asthma severity, especially early wheezing and disease control. Our findings suggest that the effects of montelukast treatment can be monitored by measuring serum eosinophilderived neurotoxin levels.

Prescription Patterns of Asthma Preventers Among Children and Adolescents Between Australia and South Korea

“…Furthermore, Suh et al (2017) found that the high LTRA prescription rate in Korea is due to the steroid phobia formed from parents of asthmatic children thinking that the use of corticosteroid would lead to serious adverse events, especially growth impairment ( Sol et al, 2019 ; Choi et al, 2018 ; Suh et al, 2017 ). A similar finding is explained in a study which looked into montelukast use over the past 20 years in South Korea ( Lee and Kim, 2020 ). Additionally, another study found that although the efficacy of montelukast in paediatric patients is inferior to that of ICSs, montelukast has no effect on growth unlike ICSs and that montelukast had a similar incidence of ADRs compared to that of the control group ( Lee and Kim, 2020 ).…”

“…A similar finding is explained in a study which looked into montelukast use over the past 20 years in South Korea ( Lee and Kim, 2020 ). Additionally, another study found that although the efficacy of montelukast in paediatric patients is inferior to that of ICSs, montelukast has no effect on growth unlike ICSs and that montelukast had a similar incidence of ADRs compared to that of the control group ( Lee and Kim, 2020 ). Secondly, the current Korean healthcare system supports medical practitioners to prescribe montelukast.…”

Huanglong Antitussive Granule Relieves Acute Asthma Through Regulating Pulmonary Lipid Homeostasis

“…Montelukast sodium, a highly selective leukotriene receptor antagonist, has significantly contributed to asthma control, e.g., reducing asthma severity, especially early wheezing and disease control, over the past 20 years, and was demonstrated decreased peripheral blood eosinophil and induced inhibition of both early and late phase bronchoconstriction in asthma patients. In clinical practice, many doctors prefer montelukast sodium over ICSs (Valentovic, 2007;Lee and Kim, 2020). However, the United States Food and Drug Administration (FDA) recently reminded a black box warning of montelukast sodium, which is severe neuropsychiatric adverse reactions and has been added to the latest Global Initiative of Asthma (GINA) (Glockler-Lauf et al, 2019; Global Strategy for Asthma Management and Prevention Global Initiative for Asthma (GINA), 2020).…”

Airway mechanics after withdrawal of a leukotriene receptor antagonist in children with mild persistent asthma: Double‐blind, randomized, cross‐over study

“…The cornerstone of treatment for persistent asthma is the stepwise adjustment of medication depending on the extent of asthma control 1 . Many studies 2‐5 and review articles 6,7 reported change of lung function and asthma control after withdrawal of inhaled corticosteroids (ICSs), as stepping down from step‐2 treatment of adults or/and children with stable and mild asthma 8‐12 . However, there is little information on pulmonary function and asthma control after the withdrawal of a leukotriene receptor antagonist (LTRA) in children who have well‐controlled mild persistent asthma 13 .…”