Jong Hoo Lee1, Hyun Jung Kim, Yee Hyung Kim. 1. Department of Internal Medicine, School of Medicine, Jeju National University Hospital, Jeju National University, Jeju City, Korea.
Abstract
BACKGROUND: Anti-leukotriene (anti-LT) agents have been not yet established for effectiveness in patients with chronic obstructive pulmonary disease (COPD). We performed a systematic review and meta-analysis to assess whether anti-LT agents have the responsiveness for COPD patients. METHODS: MEDLINE, EMBASE, Cochrane Central Register, and Korea Med were searched for relevant clinical trials to review. RESULTS: Seven studies involving 342 patients were finally analyzed. Pooled estimation from three randomized controlled studies did not demonstrate that anti-LT agents increased forced expiratory volume in 1 s [overall effect: 0.09 L, 95 % confidence interval (CI) -0.04 to 0.21; P = 0.17; I (2) = 41.0 %] or forced vital capacity (overall effect: 0.04 L, 95 % CI -0.04 to 0.11; P = 0.64; I (2) = 0.0 %). As for inflammatory markers, anti-LT agents did not affect the level of myeloperoxidase (standardized mean difference, -0.15; 95 % CI -0.65 to 0.36) or LTB4 (standardized mean difference, -0.41; 95 % CI -0.96 to 0.13). They reduced the frequency of dyspnea [relative risk (RR) 0.43; 95 % CI 0.29 to 0.64] and sputum (RR 0.37; 95 % CI 0.22 to 0.63), based on overall estimation from two non-randomized studies. However, our review revealed that there are few well-designed, randomized controlled studies with large sample sizes and long treatment durations. CONCLUSION: Although symptomatic improvements were demonstrated in some studies, there is a lack of evidence to support the therapeutic efficacy of anti-LT agents in patients with COPD. Further large-scale, long-term studies are needed to identify predictive factors for COPD patients who may benefit from anti-LT agents.
BACKGROUND: Anti-leukotriene (anti-LT) agents have been not yet established for effectiveness in patients with chronic obstructive pulmonary disease (COPD). We performed a systematic review and meta-analysis to assess whether anti-LT agents have the responsiveness for COPDpatients. METHODS: MEDLINE, EMBASE, Cochrane Central Register, and Korea Med were searched for relevant clinical trials to review. RESULTS: Seven studies involving 342 patients were finally analyzed. Pooled estimation from three randomized controlled studies did not demonstrate that anti-LT agents increased forced expiratory volume in 1 s [overall effect: 0.09 L, 95 % confidence interval (CI) -0.04 to 0.21; P = 0.17; I (2) = 41.0 %] or forced vital capacity (overall effect: 0.04 L, 95 % CI -0.04 to 0.11; P = 0.64; I (2) = 0.0 %). As for inflammatory markers, anti-LT agents did not affect the level of myeloperoxidase (standardized mean difference, -0.15; 95 % CI -0.65 to 0.36) or LTB4 (standardized mean difference, -0.41; 95 % CI -0.96 to 0.13). They reduced the frequency of dyspnea [relative risk (RR) 0.43; 95 % CI 0.29 to 0.64] and sputum (RR 0.37; 95 % CI 0.22 to 0.63), based on overall estimation from two non-randomized studies. However, our review revealed that there are few well-designed, randomized controlled studies with large sample sizes and long treatment durations. CONCLUSION: Although symptomatic improvements were demonstrated in some studies, there is a lack of evidence to support the therapeutic efficacy of anti-LT agents in patients with COPD. Further large-scale, long-term studies are needed to identify predictive factors for COPDpatients who may benefit from anti-LT agents.
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