Montelukast in the treatment of asthma and beyond

Figures & data

Figure 1. The multiple cellular effects of leukotrienes in the airways.

Redrawn with permission from [29].

Figure 2. Montelukast.

Figure 3. Subanalysis of the Clinical Outcomes with Montelukast as a Partner Agent to Corticosteroid Therapy (COMPACT) trial.

(A) No difference could be seen between adding montelukast to budesonide 400 µg twice daily, compared with doubling the dose when all patients where included. (B) For those with concomittant rhinitis, montelukast proved to be superior.

LS: Least square; SEM: Standard error of the mean.

Redrawn with permission from [87].

Figure 4. CysLT levels in exhaled breath condensate in asthmatic children, 7–18 years of age, with exercise-induced bronchoconstriction, without exercise-induced bronchoconstriction and healthy control children.

Open circles represent samples in which the CysLT concentration was less than the detection limit. Horizontal bars represent median values.

CysLT: Cysteinyl leukotriene; EIB: Exercise-induced bronchoconstriction.

Redrawn with permission from [111].

Figure 5. Effect modifiers of the montelukast effect on LTE₄-associated albuterol usage by children with asthma (n = 28; age 6–15 years).

After a 2.5-month baseline period, children were randomized to receive daily montelukast or placebo for 2.5 months (treatment interval). Urine samples were collected twice a day, on 8 consecutive days, during the baseline and the treatment interval and LTE₄ and cotinine levels were measured. Use of albuterol was monitored daily. During the baseline interval, urine LTE₄ levels in all subjects were strongly associated with increased albuterol use (21.9% increase in albuterol usage per LTE₄ interquartile range increase [IQR; p = 0.003]) 2 days after urine collection. Shown are mean estimates and 95% CI for change in albuterol use per IQR in LTE_4, modified by (A) sex and (B) mean cotinine. Estimates are given for BL and TRT.

BL: Baseline; IQR: Interquartile range; TRT: Treatment.

Redrawn with permission from [124].

Figure 6. (A) Differences between montelukast and placebo treatment in percentages of days with worse asthma symptoms in boys according to age group. (B) Differences between montelukast and placebo treatment in percentages of days with worse asthma symptoms in girls according to age group.

NS: Not significant.

Redrawn with permission from [134].

Table 1. Adverse events occurring in 3% or more of patients regardless of relationship to study medication, in a pooled analysis of ten Phase IIb/III trials.

Adverse event	Montelukast (n = 1955)			Placebo (n = 1180)
	n	%		n	%
Upper respiratory tract infection	420	21.5		290	24.6
Headache	360	18.4		214	18.1
Asthma	275	14.1		233	19.7
Pharyngitis	106	5.4		83	7.0
Influenza	82	4.2		46	3.9
Sinusitis	79	4.0		51	4.3
Diarrhea	61	3.1		36	3.1
Bronchitis	47	2.4		42	3.6
Abdominal pain	56	2.9		29	2.5
Nausea	50	2.6		35	3.0
Rhinitis	15	0.8		16	1.4

Data taken from [81] with permission. © Blackwell Publishing.

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