Greater Role for Leukotriene-Receptor Antagonists in Asthma?

In real-world practices, these drugs compared favorably with guideline-recommended first-line agents.

NIH asthma guidelines recommend inhaled corticosteroids (ICS) as first-line treatment for patients who have mild persistent asthma, with addition of a long-acting ?-agonist (LABA) for uncontrolled symptoms. Previous double-blind randomized trials — conducted with tightly managed methodology — typically showed that ICS and LABAs were superior to leukotriene-receptor antagonists (LTRAs) for those indications. Now, two open-label randomized pragmatic U.K. studies provide a real-world perspective.


In one study, 300 treatment-naive asthma patients received oral LTRAs (montelukast [Singulair] or zafirlukast [Accolate and generics]) or ICS (beclomethasone, budesonide, or fluticasone). In the other study, 350 patients with uncontrolled symptoms who already were receiving low-dose ICS received an LTRA or a LABA. The patients (age range, 12–80) were managed in 53 primary care practices; patients' primary physicians determined asthma diagnoses and need for step-up therapy. The primary outcome was asthma-related quality of life, and secondary endpoints included asthma control and exacerbations. In both the first-line and add-on studies, no significant differences were found between the LTRA groups and the comparison groups for any outcomes during 2-year follow-up. Adherence rates were higher for LTRAs than for ICS (65% vs. 41% in the first-line trial) or LABAs (74% vs. 46% in the add-on trial).


Citation(s):

Price D et al. Leukotriene antagonists as first-line or add-on asthma-controller therapy. N Engl J Med 2011 May 5; 364:1695.

Dahlén S-E et al. Asthma-treatment guidelines meet the real world. N Engl J Med 2011 May 5; 364:1769.