The Pharmaceutical Journal
Vol 270 No 7241 p390
22 March 2003

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Thorax abstracts one and two

Uncontrolled adult asthma patients benefit from add-on montelukast

The value of leukotriene receptor antagonists in uncontrolled adult asthma has been confirmed in two large randomised trials.

The studies, with acronyms COMPACT and CASIOPEA, have been published in Thorax (2003;58:204 and 211).

The international COMPACT study involved just under 900 patients with asthma inadequately controlled by inhaled budesonide 800µg/day. Patients were randomised to receive either the leukotriene antagonist montelukast 10mg/day in addition to existing treatment, or to double the dose of steroid. After 12 weeks, both groups had better peak flow, fewer symptoms and used less rescue medication than at baseline. The group assigned to montelukast had a faster response than those assigned to increased steroid use.

The Spanish CASIOPEA study, of 639 patients, compared montelukast 10mg daily or placebo for 16 weeks. All patients received a constant dose of budesonide (400–1,600µg/day) throughout the study.

Patients using montelukast had 35 per cent fewer exacerbation days, more asthma free days (56 per cent) and fewer night wakenings than those given placebo. The treatment group also had greater improvements in morning peak flow and used less rescue medication. The authors of this study conclude that, for patients with mild airway obstruction and persistent asthma symptoms, concomitant treatment with montelukast provided significant additional benefit.

New joint guidelines from the British Thoracic Society and Scottish Intercollegiate Guidelines Network include leukotriene antagonists for the first time as add-on therapy in asthma before increasing inhaled steroids to high levels (PJ, 1 February, p141 and 8 February, p182).