@article{5b77cf65d45f4d1da009c3d9d1224953,
title = "Risk factors for montelukast treatment failure in step-down therapy for controlled asthma",
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.",
keywords = "Asthma, Leukotrienes, Therapy",
author = "Drummond, {M. Bradley} and Peters, {Stephen P.} and Mario Castro and Holbrook, {Janet T.} and Irvin, {Charles G.} and Smith, {Lewis J.} and Wise, {Robert A.} and Sugar, {Elizabeth A.}",
note = "Funding Information: Dr. Peters serves as an advisor to the DCC of the American Lung Association (ALA) Asthma Clinical Research Centers and served as principal investigator of the ALA Asthma Clinical Research Centers{\textquoteright} LOCCS trial which was supported by an unrestricted grant to the ALA by GlaxoSmithKline. Dr. Castro received $10,001–$50,000 from Asthmatx in consultancy fees; $5001–$10,000 from Genentech in advisory board fees; $50,001–$100,000 from AstraZeneca, $10,001–$50,000 from Boehringer-Ingelheim, $10,001–$50,000 from Pfizer, $5001–$10,000 from Genentech, and $10,001–$50,000 from Merck in lecture fees; more than $100,001 from Asthmatx, more than $100,001 from Amgen, more than $100,001 from Centocor, more than $100,001 from Ception, more than $100,001 from Genentech, more than $100,001 from GlaxoSmithKline, more than $100,001 from MedImmune, more than $100,001 from Merck, and more than $100,001 from Novartis in industry-sponsored grants; and $1001–$5,000 from Elsevier in royalties. Dr. Irvin has received grant support from the ALA and National Institutes of Health. He has served as a board member for Methapharm and received payment for lectures from Merck. He has received royalties for work related to now up-to-date. Dr. Wise has served as a paid consultant for AstraZeneca, Boehringer-Ingelheim Pharmaceuticals, GlaxoSmithKline, Pfizer, Novartis, Sunovion, Telacris, and Spiration. He has received research grants from Boehringer-Ingelheim Pharmaceuticals and GlaxoSmithKline. Funding for this publication was made possible in part by a Mentored Patient-Oriented Research Career Development Award (K23) from the National Institutes of Health-National Heart, Lung and Blood Institute (MBD). Funding for the original LOCCS study was provided in part by the ALA and GlaxoSmithKline. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.",
year = "2011",
month = dec,
doi = "10.3109/02770903.2011.627488",
language = "English (US)",
volume = "48",
pages = "1051--1057",
journal = "Journal of Asthma",
issn = "0277-0903",
publisher = "Informa Healthcare",
number = "10",
}