Risk factors for montelukast treatment failure in step-down therapy for controlled asthma

M. Bradley Drummond, Stephen P. Peters, Mario Castro, Janet T. Holbrook, Charles G. Irvin, Lewis J. Smith, Robert A. Wise, Elizabeth A. Sugar

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Leukotriene receptor antagonists including montelukast are an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Because some patients fail montelukast step-down therapy, it would be helpful for clinicians to be able to predict the risk of treatment failure. Objectives. To determine patient characteristics associated with montelukast treatment failure and develop a clinical index to predict the risk of montelukast treatment failure. Methods. Using the 165 participants in the Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial who were stepped down from low-dose ICS to montelukast, we determined associations between enrollment variables and treatment failure. We constructed a montelukast failure index to predict the risk of montelukast treatment failure during step-down. To assess its specificity for montelukast, index performance was evaluated in the other LOCCS treatment groups. Results. Characteristics independently associated with montelukast treatment failure included age of asthma onset <10 years old (OR = 2.39; 95% CI = 1.175.02; p = .018), need for steroid burst in the last year (OR = 2.39; 95% CI = 1.135.09; p = .022), and pre-bronchodilator forced expiratory volume in 1 s (FEV1) (OR = 1.44 per 10% lower % predicted; 95% CI = 1.071.97; p = .016). A montelukast failure index was generated from these three variables (range: -5 to 7 points). Scores <0 predicted low risk (<0.20) of treatment failure, whereas scores >5 predicted high risk (>0.60) of treatment failure. Conclusion. Early asthma onset, worse asthma control in the last year, and lower pre-bronchodilator FEV1 are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation.

Original languageEnglish (US)
Pages (from-to)1051-1057
Number of pages7
JournalJournal of Asthma
Volume48
Issue number10
DOIs
StatePublished - Dec 2011

Keywords

  • Asthma
  • Leukotrienes
  • Therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

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