Clinical Question: Are the leukotriene inhibitors as effective as inhaled corticosteroids in the treatment of asthma in children and adults?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: Two leukotriene inhibitors, montelukast and zafirlukast, offer the advantage of oral therapy in the treatment of asthma in children and adults. This study combined the results of 13 studies (only one was performed in children) that compared these leukotriene inhibitors with inhaled corticosteroids as single therapies in patients with mild to moderate asthma, with the exception that short-acting beta agonists could be used as rescue therapy. One investigator performed the literature search, and two reviewers considered the studies for inclusion and performed the data extraction.

Compared with patients who were treated with an inhaled steroid, those who used a leukotriene inhibitor were 60 percent more likely to experience an exacerbation of their condition, defined as an episode requiring the use of systemic steroids (number needed to treat, 27; 95 percent confidence interval, 13 to 81). Patients using the inhaled steroid had fewer nocturnal awakenings per week, required less rescue therapy with beta agonists, and had approximately 10 percent fewer days with symptoms. Patients taking leukotriene inhibitors were 2.5 times as likely to withdraw from a study because of poor control of their asthma.

Bottom Line:The leukotriene inhibitors montelukast and zafirlukast are less effective than inhaled corticosteroids in controlling symptoms in patients with mild to moderate asthma. (Level of Evidence: 1a)