Montelukast for prevention and treatment of asthma exacerbations in adults: Systematic review and meta-analysis.
Montelukast for prevention and treatment of asthma exacerbations in adults: Systematic review and meta-analysis.
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DOI：
10.2500/aap.2014.35.3745
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发表时间：
2014-07
影响因子：
2.8
通讯作者：
H. P. Zhang;Chun E Jia;Yan Lv;P. Gibson;Gang Wang
中科院分区：
文献类型：
--
作者：
H. P. Zhang;Chun E Jia;Yan Lv;P. Gibson;Gang Wang
已证实其在减少哮喘急性发作方面的有效性，但孟鲁司特（一种白三烯受体拮抗剂）对不同严重程度的哮喘急性发作的效应大小尚未进行系统评估。本研究旨在系统地探讨孟鲁司特作为一线或添加治疗预防和治疗成人哮喘患者哮喘急性发作的证据。在PubMed、CENTRAL、Web of Science、Embase和奥维德中检索了截至2013年3月的随机对照试验，其中孟鲁司特预防或治疗成人哮喘急性发作。主要结果是慢性哮喘急性发作和急性哮喘住院的患者数量。计算并汇总比值比（OR）和95%置信区间（CI）、风险差异和需要治疗的人数（NNT）。还评估了慢性哮喘的不良事件。确定了20项慢性哮喘试验和6项急性哮喘试验。与安慰剂相比，接受孟鲁司特治疗的慢性哮喘成人患者的急性发作次数显著减少（OR = 0.60和95%CI，0.49，0.74; NNT = 17和95%CI，12，29）。但孟鲁司特的疗效不如吸入性皮质类固醇（ICS）（OR = 1.63; 95% CI，1.29，2.0）和ICS+长效β 2受体激动剂（LABA; OR = 3.94; 95% CI，1.64，9.48）作为一线治疗，LABA（OR = 1.22; 95% CI，1.05，1.42）作为辅助治疗，以减少哮喘急性发作。在急性哮喘中，孟鲁司特可统计学上改善最大呼气流量百分比预测值（p = 0.008），并减少全身皮质类固醇摄入量（p = 0.005）。孟鲁司特钠对声音嘶哑和失眠的风险较低。我们的荟萃分析表明，孟鲁司特可显著降低慢性轻中度哮喘的轻度、中度和部分重度急性发作，但其疗效不如ICS或ICS + LABA。
It has proven efficacy in reducing asthma exacerbations, but the effect size of montelukast (a leukotriene receptor antagonist) for varied severity of asthma exacerbations is not systematically assessed. This study was designed to systematically explore the evidence for montelukast, as first-line or add-on therapy, in preventing and treating asthma exacerbations in adult patients with asthma. Randomized controlled trials were searched in PubMed, CENTRAL, Web of Science, Embase, and OVID up to March 2013, where montelukast prevented or treated asthma exacerbations in adults. Primary outcomes were the number of patients experiencing exacerbations in chronic asthma and hospitalizations in acute asthma. Odds ratio (OR) with 95% confidence intervals (CI), risk difference, and number needed to treat (NNT) were calculated and pooled. Adverse events were also assessed in chronic asthma. Twenty trials for chronic asthma and six for acute asthma were identified. In comparison with placebo, adults with chronic asthma receiving montelukast had significantly reduced number of exacerbations (OR = 0.60 and 95% CI, 0.49, 0.74; NNT = 17 and 95% CI, 12, 29). However, montelukast was inferior to inhaled corticosteroids (ICSs) (OR = 1.63; 95% CI, 1.29, 2.0) and ICS plus long-acting beta2-agonist (LABA; OR = 3.94; 95% CI, 1.64, 9.48) as the first-line therapies and LABA (OR = 1.22; 95% CI, 1.05, 1.42) as the add-on therapies in reducing asthma exacerbations. In acute asthma, montelukast could statistically improve peak expiratory flow percent predicted (p = 0.008) and reduce systemic corticosteroid intake (p = 0.005). Montelukast had low risk in hoarseness and insomnia. Our meta-analysis suggests that montelukast significantly reduces mild, moderate, and part of severe exacerbations in chronic mild to moderate asthma, but it has inferior efficacy to ICS or ICS plus LABA.