Krishna Moorthy, Madhusudhan
(2020)
Efficacy of montelukast in allergic rhinitis Treatment:
A systematic review and meta-analysis.
PhD thesis, Universiti Sains Malaysia.
Abstract
In treating allergic rhinitis (AR), montelukast has the potential to be used as
an alternative or addition to oral antihistamine (OAH) or intranasal corticosteroid.
Objectives: To assess the effectiveness of montelukast in treating AR.
Methods: An electronic literature search was performed using Cochrane Central Register of
Controlled Trials, EMBASE and MEDLINE from 1966 to 21st January 2019. The eligibility
criteria were randomized control trials comparing montelukast with placebo or other standard
treatments. The primary outcomes assessed were daytime nasal symptom score (DNS) and
nighttime nasal symptom score (NNS). The secondary outcomes assessed were composite
nasal symptom score (CSS), daytime eyes symptom score (DES) and rhinoconjunctivitis
quality of life questionnaires (RQLQ). Meta-analysis was done using Review Manager 5.3
software based on the random-effects model.
Results: Fifteen studies of 10387 participants met the inclusion criteria. Montelukast was
effective than placebo in improving DNS (MD -0.12, 95% CI -0.15 to -0.08; P < 0.001), NNS
(MD -0.09, 95% CI -0.13 to -0.05; P < 0.001), CSS (MD -0.08, 95% CI -0.11 to -0.06; P <
0.001), DES (MD -0.17, 95% CI -0.33 to -0.02; P < 0.030) and RQLQ (MD -0.34, 95% CI -
0.49 to -0.20; P < 0.001). OAH was superior than montelukast in improving DNS (MD 0.08,
95% CI 0.03 to 0.13; P=0.002), CSS (MD 0.03, 95% CI -0.02 to 0.07; P=0.270), DES (MD
0.06, 95% CI 0 to 0.12; P=0.040) and RQLQ (MD 0.03, 95% CI -0.05 to 0.12; P=0.430).
Montelukast was superior than OAH in improving NNS (MD -0.03, 95% CI -0.08 to 0.03;
P=0.330). Intranasal fluticasone spray was superior than montelukast in improving DNS
(MD 0.71, 95% CI 0.44 to 0.99; P < 0.001) and NNS (MD 0.63, 95% CI 0.29 to 0.97; P <
0.001). A combined montelukast and OAH was superior than OAH in in improving DNS
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(MD -0.15, 95% CI -0.27 to -0.03; P =0.010), NNS (MD -0.16, 95% CI -0.28 to -0.05; P
=0.006), CSS (MD -0.12, 95% CI -0.25 to -0.01; P =0.070), DES (MD -0.12, 95% CI -0.30
to 0.06; P =0.180) and RQLQ (MD -0.10, 95% CI -0.28 to 0.08; P =0.290). A combined
montelukast and OAH was superior than montelukast improving DNS (MD 0.15, 95% CI
0.08 to 0.21; P<0.001), NNS (MD 0.05, 95% CI -0.09 to 0.19; P=0.510), CSS (MD 0.1, 95%
CI 0.03 to 0.17; P=0.007), DES (MD 0.18, 95% CI 0 to 0.36; P=0.050) and RQLQ (MD 0.07
95% CI -0.15 to 0.29; P=0.530).
Conclusion: Montelukast is effective in treating AR patients with nocturnal symptoms and
as add on combination therapy with OAH in the stepping up management of AR.
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