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Meta-Analysis
. 2023 Oct 18;32(170):230124.
doi: 10.1183/16000617.0124-2023. Print 2023 Dec 31.

Montelukast in paediatric asthma and allergic rhinitis: a systematic review and meta-analysis

Karina Mayoral  1   2   3   4 , Catalina Lizano-Barrantes  1   5   6   4 , Víctor Zamora  1   2   3 , Angels Pont  1   3 , Carme Miret  2   7   8 , Cristina Barrufet  8 , M Araceli Caballero-Rabasco  2   9 , Manuel Praena-Crespo  10   11 , Alberto Bercedo  11   12 , Laura Valdesoiro-Navarrete  13 , Maria Teresa Guerra  14 , Yolanda Pardo  1   3   15 , Mª José Martínez Zapata  3   16 , Olatz Garin  1   3   5 , Montse Ferrer  17   3   5 ; ARCA Group
Affiliations
Meta-Analysis

Montelukast in paediatric asthma and allergic rhinitis: a systematic review and meta-analysis

Karina Mayoral et al. Eur Respir Rev. .

Abstract

Background: We aim to assess the impact of montelukast on paediatric patients with asthma/allergic rhinitis, measured using patient-reported outcome measures, compared with other treatments or placebo.

Methods: Protocol registration CRD42020216098 (www.crd.york.ac.uk/PROSPERO). MEDLINE and Embase databases were used to conduct the search. Two authors independently selected studies and extracted data, and a third reviewer resolved discrepancies. Meta-analyses were constructed to estimate the standardised mean difference (SMD) using a random-effects model.

Results: Out of 3937 articles identified, 49 studies met the inclusion criteria, mostly randomised clinical trials (sample sizes: 21-689 patients). The SMD of change pooled estimators for the global, mental and physical domains of health-related quality of life were not statistically significant. For daytime and night-time symptoms scores, the SMD (95% CI) was in favour of inhaled corticosteroids (-0.12, -0.20- -0.05 and -0.23, -0.41- -0.06, respectively). The pooled estimator for global asthma symptoms was better for montelukast when compared with placebo (0.90, 0.44-1.36).

Conclusions: The synthesis of the available evidence suggests that, in children and adolescents, montelukast was effective in controlling asthma symptoms when compared with placebo, but inhaled corticosteroids were superior in controlling symptoms, especially at night-time. These findings of our systematic review concur with current guidelines for asthma treatment.

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Conflict of interest statement

Conflict of interest: All authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the systematic literature review.
FIGURE 2
FIGURE 2
a) Risk-of-bias summary for randomised controlled trials using the revised tool for risk of bias (RoB 2) in randomised trials; b) risk of bias of nonrandomised studies assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool.
FIGURE 3
FIGURE 3
Forest plots of studies comparing patients with asthma treated with inhaled corticosteroids (ICS) in monotherapy or as a combined treatment with long-acting β-agonists (LABAs) versus montelukast in terms of health-related quality of life (HRQoL). a) Global scores of HRQoL for monotherapy; b) global scores of HRQoL for combined therapy; c) mental and d) physical dimension scores of HRQoL for monotherapy. SMD: standardised mean difference; IV: inverse variance. #: study including more than one dose of ICS; 400 μg budesonide was used.
FIGURE 4
FIGURE 4
Forest plot of studies comparing patients with asthma treated with inhaled corticosteroids (ICS) versus montelukast in terms of symptoms. a) Daytime symptom score; b) night-time symptom score; c) global symptom score. SMD: standardised mean difference; IV: inverse variance. #: study including more than one dose of ICS; 400 μg budesonide was used.
FIGURE 5
FIGURE 5
Forest plot of studies comparing patients with asthma treated with placebo versus montelukast in terms of symptoms. a) Daytime symptom score; b) night-time symptom score; c) global symptom score. SMD: standardised mean difference; IV: inverse variance.
See this image and copyright information in PMC

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