BACKGROUND: The risks of using leukotriene receptor antagonists (LTRA) as part of a strategy for stepping down inhaled corticosteroid (ICS) are not well known. OBJECTIVE: To estimate the risk of asthma exacerbation in individuals with stable asthma who start LTRA when stopping ICS or reducing ICS dose. METHODS: We identified articles from a systematic review of English and non-English articles by using a number of data bases. We included randomized controlled trials with a stable asthma run-in period of 4 weeks or more and a follow-up period of at least 3 months. We included studies of individuals with stable asthma who stopped ICS and substituted LTRA (versus continuing ICS) and who reduced ICS while starting LTRA (versus placebo). RESULTS: The search strategy identified 1132 potential articles, of which 52 were reviewed at the full-text level, and four met criteria for inclusion. The single article that met the inclusion criteria for substitution of LTRA for ICS as a step-down strategy found a statistically increased risk of treatment failure of 30.3% for substituting LTRA compared with 20.2% for continuing ICS. The three articles that met the inclusion criteria for comparing LTRA versus placebo in patients with stable asthma who reduce ICS found a modestly decreased risk ratio that favored LTRA of 0.57 (95% confidence interval, 0.36-0.90; I(2) = 0%) in studies that only included individuals >15 years old. CONCLUSION: Only one study addressed the risk of substitution of LTRA for ICS in stable asthma, which limited any strong conclusions about this step-down strategy.
BACKGROUND: The risks of using leukotriene receptor antagonists (LTRA) as part of a strategy for stepping down inhaled corticosteroid (ICS) are not well known. OBJECTIVE: To estimate the risk of asthma exacerbation in individuals with stable asthma who start LTRA when stopping ICS or reducing ICS dose. METHODS: We identified articles from a systematic review of English and non-English articles by using a number of data bases. We included randomized controlled trials with a stable asthma run-in period of 4 weeks or more and a follow-up period of at least 3 months. We included studies of individuals with stable asthma who stopped ICS and substituted LTRA (versus continuing ICS) and who reduced ICS while starting LTRA (versus placebo). RESULTS: The search strategy identified 1132 potential articles, of which 52 were reviewed at the full-text level, and four met criteria for inclusion. The single article that met the inclusion criteria for substitution of LTRA for ICS as a step-down strategy found a statistically increased risk of treatment failure of 30.3% for substituting LTRA compared with 20.2% for continuing ICS. The three articles that met the inclusion criteria for comparing LTRA versus placebo in patients with stable asthma who reduce ICS found a modestly decreased risk ratio that favored LTRA of 0.57 (95% confidence interval, 0.36-0.90; I(2) = 0%) in studies that only included individuals >15 years old. CONCLUSION: Only one study addressed the risk of substitution of LTRA for ICS in stable asthma, which limited any strong conclusions about this step-down strategy.
Authors: Gordon H Guyatt; Kristian Thorlund; Andrew D Oxman; Stephen D Walter; Donald Patrick; Toshi A Furukawa; Bradley C Johnston; Paul Karanicolas; Elie A Akl; Gunn Vist; Regina Kunz; Jan Brozek; Lawrence L Kupper; Sandra L Martin; Joerg J Meerpohl; Pablo Alonso-Coello; Robin Christensen; Holger J Schunemann Journal: J Clin Epidemiol Date: 2012-10-30 Impact factor: 6.437
Authors: Matthew A Rank; John B Hagan; Miguel A Park; Jenna C Podjasek; Shefali A Samant; Gerald W Volcheck; Patricia J Erwin; Colin P West Journal: J Allergy Clin Immunol Date: 2013-01-12 Impact factor: 10.793
Authors: Stephen P Peters; Nicholas Anthonisen; Mario Castro; Janet T Holbrook; Charles G Irvin; Lewis J Smith; Robert A Wise Journal: N Engl J Med Date: 2007-05-17 Impact factor: 91.245
Authors: Y Tohda; M Fujimura; H Taniguchi; K Takagi; T Igarashi; H Yasuhara; K Takahashi; S Nakajima Journal: Clin Exp Allergy Date: 2002-08 Impact factor: 5.018