Leukotriene receptor antagonists versus placebo in adults and adolescents with asthma: a systematic review and meta-analysis.
Background: Leukotriene receptor antagonists (LTRAs) are recommended as alternative
treatment in patients with mild asthma, but their relative effect compared with placebo
is unknown. Objective: To determine the benefits and harms of LTRAs compared with
placebo in adults and adolescents with asthma. Data sources: MEDLINE and the Cochrane
Central Register of Controlled Trials from ... read moreinception through December 2012. Study
selection: Peer–reviewed, English–language, randomized controlled trials (
≥ 4 weeks in duration) in patients with asthma that reported the effect of LTRAs
versus placebo on measures of asthma control. Data extraction: Data on the study
population, interventions, outcome measures, adverse events, and study methodology were
extracted by three authors. Data synthesis: Forty seven trials satisfied our eligibility
criteria. Random–effects model meta–analyses, random–effects
meta–regression, and subgroup analyses were performed. In 9 trials, LTRAs reduced
the risk of an exacerbation by 35% (summary risk ratio = 0.65, 95% CI 0.50, 0.84). The
effect was more pronounced in studies of shorter duration (p < 0.01). LTRAs
significantly increased FEV1 (summary mean difference [MD] from 13 trials= 0.11 liters,
95% CI 0.08, 0.15; summary MD in percent change from 11 trials = 5.95, 95% CI 3.3, 8.6)
and FEV1 % predicted (summary MD from 8 trials = 4.2%, 95% CI 1.5, 1.9). Daytime
symptoms (summary standardized MD from 14 trials = −0.21, 95% CI −0.37,
−0.04), short-acting β2–agonist use (summary MD from 11 trials =
−0.65 puffs/day, 95% CI −0.82, −0.49; summary MD in percent change
from 8 trials = −16.4, 95% CI −22.4, −10.4), nocturnal awakenings
(summary MD from 7 trials= −0.66, 95% CI −1,−0.3), and
asthma–specific quality of life (summary standardized MD from 5 trials = 0.13,
95% CI 0.02, 0.2) were also significantly improved compared to placebo. The proportions
of patients with adverse events were similar between intervention and comparator groups.
Limitations: Variation in definitions and reporting of outcomes, large heterogeneity,
and possible selective outcome reporting bias. Conclusion: LTRAs improved asthma control
compared to placebo. It remains unclear however, which patients with asthma are more
likely to respond to treatment with LTRAs.
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Kent.
Committee: Ethan Balk, Christopher Schmid, and Sucharita Kher.
Keyword: Health sciences.read less