Leukotriene receptor antagonist (LTRA) montelukast is an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Some patients fail montelukast step-down therapy, and it would be helpful to predict this risk. The Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial included 165 participants.
Characteristics independently associated with montelukast treatment failure included:
- age of asthma onset <10 years old (OR = 2.39)
- need for steroid burst in the last year (OR = 2.39)
- pre-bronchodilator forced expiratory volume in 1 s (FEV1) (OR = 1.44 per 10% lower % predicted)
The montelukast failure index was based on these 3 variables (range: −5 to 7 points):
- scores <0 predicted low risk of treatment failure
- scores >5 predicted high risk of treatment failure
Early asthma onset, worse asthma control in the last year, and lower FEV1 are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation.
Risk Factors for Montelukast Treatment Failure in Step-Down Therapy for Controlled Asthma. Drummond MB, Peters SP, Castro M, Holbrook JT, Irvin CG, Smith LJ, Wise RA, Sugar EA. J Asthma. 2011 Oct 27.
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