Are leukotriene inhibitors still used in asthma management protocols?

From the Guidelines

Leukotriene inhibitors are still used in asthma management protocols, primarily as adjunctive or alternative therapy for patients with mild persistent asthma who are unable or unwilling to use inhaled corticosteroids. These medications, including montelukast (Singulair) and zafirlukast (Accolate), work by blocking the effects of leukotrienes, which are inflammatory mediators that cause bronchoconstriction, increased mucus production, and airway edema 1. The most recent and highest quality study available is from 2010, which suggests that montelukast and zafirlukast are appropriate alternative therapies for mild persistent asthma in patients who are unable or unwilling to use inhaled corticosteroids 1. Some key points to consider when using leukotriene inhibitors include:

• Montelukast is taken once daily, whereas zafirlukast is used twice daily 1
• Combining leukotriene receptor antagonists and inhaled corticosteroids is an alternative for moderate persistent asthma, but studies of this combination have been limited 1
• Leukotriene inhibitors may be particularly useful for patients with aspirin-sensitive asthma, exercise-induced bronchoconstriction, or those who cannot use or do not respond adequately to inhaled corticosteroids
• Healthcare providers should be aware of potential side effects, although the provided evidence does not mention neuropsychiatric side effects, and consider the risk-benefit profile, especially when prescribing to children and adolescents. It's worth noting that while the 2007 study provides additional context on asthma management, the 2010 study is more recent and directly addresses the use of leukotriene inhibitors 1.

From the FDA Drug Label

The efficacy of SINGULAIR for the chronic treatment of asthma in adults and adolescents 15 years of age and older was demonstrated in two (U. S. and Multinational) similarly designed, randomized, 12-week, double-blind, placebo-controlled trials in 1576 patients (795 treated with SINGULAIR, 530 treated with placebo, and 251 treated with active control). Daily administration of SINGULAIR for the chronic treatment of asthma has not been established to prevent acute episodes of exercise-induced bronchoconstriction SINGULAIR should be taken once daily in the evening.

Leukotriene inhibitors, such as montelukast, are still used in asthma management protocols. They are used for the chronic treatment of asthma in adults and adolescents 15 years of age and older, and are taken once daily in the evening. However, they are not intended to prevent acute episodes of exercise-induced bronchoconstriction 2, 2.

From the Research

Leukotriene Inhibitors in Asthma Management

• Leukotriene inhibitors, such as montelukast, are still used in asthma management protocols, particularly as add-on therapy to inhaled corticosteroids (ICS) for patients whose asthma is not controlled by ICS alone 3, 4.
• Studies have shown that leukotriene receptor antagonists (LTRAs) can reduce the need for inhaled corticosteroids while maintaining asthma control 5.
• However, the effectiveness of LTRAs is generally considered to be less than that of long-acting beta2-agonists (LABAs) as add-on therapy to ICS 3, 4.
• Montelukast, a leukotriene receptor antagonist, has been shown to reduce asthma exacerbations and improve lung function, symptoms, and quality of life in patients with chronic asthma 6.
• The benefits of antileukotrienes in the treatment of asthma are considered to outweigh their risks, although they are generally less effective than inhaled corticosteroids and LABAs 7.

Comparison with Other Treatments

• Leukotriene inhibitors have been compared to other treatments, such as LABAs and inhaled corticosteroids, in terms of their effectiveness in reducing asthma exacerbations and improving lung function 3, 4, 6.
• Studies have shown that LABAs are generally more effective than leukotriene inhibitors as add-on therapy to ICS, but leukotriene inhibitors may be useful for patients who cannot tolerate LABAs or have certain genetic polymorphisms 3, 4, 7.

Specific Patient Populations

• Leukotriene inhibitors may be particularly useful for patients with exercise-induced asthma, as they can prevent symptoms without inducing tolerance 7.
• They may also be useful for patients who require high doses of inhaled corticosteroids, as they can help reduce the need for these medications while maintaining asthma control 5.