From the Guidelines
Singulair (montelukast) should not be used as a treatment for eosinophilic esophagitis (EoE) outside of a clinical trial setting. The most recent and highest quality study, published in 2020 in the journal Gastroenterology 1, suggests that montelukast, along with other therapies such as cromolyn, immunomodulators, and anti-TNF, should only be considered in the context of a clinical trial due to limited evidence for their effectiveness in EoE.
Key Points to Consider
- The study found that montelukast did not show any difference in symptoms compared to placebo in a small randomized controlled trial (RCT) of 41 adult participants 1.
- There is a lack of high-quality evidence to support the use of montelukast in EoE, and its mechanism of action as a leukotriene receptor antagonist may not be directly relevant to the pathogenesis of EoE.
- Treatment of EoE should focus on established therapies such as proton pump inhibitors (PPIs), topical steroids, and dietary modifications, which have a stronger evidence base for effectiveness.
- Patients with EoE should be managed comprehensively, with regular follow-up and possibly repeat endoscopies to assess response to therapy.
Important Considerations
- The use of montelukast in EoE is not recommended due to the limited evidence and potential for side effects, including mood changes, behavior changes, and rarely neuropsychiatric symptoms.
- Any consideration of montelukast or other alternative therapies should be made in the context of a clinical trial or with careful monitoring and discussion of the potential risks and benefits with the patient.
From the Research
Treatment Options for Eosinophilia Esophagitis
- The main treatment options for eosinophilia esophagitis include dietary modifications, swallowed topical corticosteroids (STCs), proton pump inhibitors (PPIs), and esophageal dilation 2, 3, 4, 5, 6
- Dietary modifications, such as elimination diets, can be effective in inducing remission in patients with eosinophilia esophagitis 2, 5
- Swallowed topical corticosteroids, such as fluticasone and budesonide, have been shown to be effective in inducing histologic remission in patients with eosinophilia esophagitis 3, 4, 6
- Proton pump inhibitors, such as omeprazole, have been shown to be effective in inducing histologic remission in some patients with eosinophilia esophagitis, although the response rate is lower compared to topical corticosteroids 3, 6
- Esophageal dilation may be necessary for patients with symptomatic esophageal narrowing or strictures 2, 5, 6
Singulair (Montelukast) for Eosinophilia Esophagitis
- There is no direct evidence in the provided studies to support the use of Singulair (montelukast) for the treatment of eosinophilia esophagitis
- However, montelukast is a leukotriene receptor antagonist that has anti-inflammatory properties and is used to treat other conditions such as asthma 5
- Further research is needed to determine the efficacy and safety of montelukast for the treatment of eosinophilia esophagitis
Emerging Therapies for Eosinophilia Esophagitis
- New formulations of STCs, such as viscose formulations and effervescent orodispersible tablets, are being developed to target the esophagus and provide increased effectiveness at lower doses 4
- Biologics, such as dupilumab, which targets interleukin 4 and 13 signaling pathways, have shown promising results in clinical trials and may be a potential treatment option for eosinophilia esophagitis 5