PDF(Pubmed)
Abstract：
BACKGROUND: Montelukast is a highly selective and specific cysteinyl leukotriene receptor antagonist used in the treatment of asthma. Whether montelukast as adjuvant therapy can significantly and safely treat adults with cough variant asthma (CVA) remains inconclusive.
OBJECTIVE: This meta-analysis systematically evaluated the efficacy and safety of montelukast as an adjuvant treatment for adults with CVA.
METHODS: Randomized controlled trials (RCTs) on montelukast combined with inhaled corticosteroids (ICS) and long-acting β2 agonists (LABAs) to treat CVA in adults, from inception to March 6, 2023, were retrieved from the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, and Web of Science databases and Clinical Trials website. Review Manager (version 5.4) and Stata (version 15.0) were used to conduct the meta-analysis.
RESULTS: A total of 15 RCTs were ultimately included in the meta-analysis. It was established that montelukast as adjuvant therapy raised the total effective rate (RR = 1.20, 95% confidence interval [CI] [1.13, 1.27], P < 0.01) and improved the FEV1% (SMD = 0.91, 95% CI [0.40, 1.41], P < 0.01), PEF% (SMD = 0.63, 95% CI [0.38, 0.88], P < 0.01), FEV1 (SMD = 1.15, 95% CI [0.53, 1.77], P < 0.01), PEF (SMD = 0.64, 95% CI [0.42, 0.86], P < 0.01), and FEV1/FVC% (SMD = 0.76, 95% CI [0.51, 1.01], P < 0.01) and reduced the recurrence rate (RR = 0.28, 95% CI [0.15, 0.53], P < 0.01). The incidence of adverse reactions was higher in the montelukast auxiliary group compared to the control group but with no statistical difference (RR = 1.32, 95% CI [0.89, 1.96], P = 0.17).
CONCLUSIONS: Existing evidence indicated that the use of montelukast as an adjuvant therapy had therapeutic efficacy superior to ICS + LABA alone for the treatment of adult patients with CVA. However, further research is needed, especially a combination of high-quality long-term prospective studies and carefully designed RCTs.
OBJECTIVE: This meta-analysis systematically evaluated the efficacy and safety of montelukast as an adjuvant treatment for adults with CVA.
METHODS: Randomized controlled trials (RCTs) on montelukast combined with inhaled corticosteroids (ICS) and long-acting β2 agonists (LABAs) to treat CVA in adults, from inception to March 6, 2023, were retrieved from the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, and Web of Science databases and Clinical Trials website. Review Manager (version 5.4) and Stata (version 15.0) were used to conduct the meta-analysis.
RESULTS: A total of 15 RCTs were ultimately included in the meta-analysis. It was established that montelukast as adjuvant therapy raised the total effective rate (RR = 1.20, 95% confidence interval [CI] [1.13, 1.27], P < 0.01) and improved the FEV1% (SMD = 0.91, 95% CI [0.40, 1.41], P < 0.01), PEF% (SMD = 0.63, 95% CI [0.38, 0.88], P < 0.01), FEV1 (SMD = 1.15, 95% CI [0.53, 1.77], P < 0.01), PEF (SMD = 0.64, 95% CI [0.42, 0.86], P < 0.01), and FEV1/FVC% (SMD = 0.76, 95% CI [0.51, 1.01], P < 0.01) and reduced the recurrence rate (RR = 0.28, 95% CI [0.15, 0.53], P < 0.01). The incidence of adverse reactions was higher in the montelukast auxiliary group compared to the control group but with no statistical difference (RR = 1.32, 95% CI [0.89, 1.96], P = 0.17).
CONCLUSIONS: Existing evidence indicated that the use of montelukast as an adjuvant therapy had therapeutic efficacy superior to ICS + LABA alone for the treatment of adult patients with CVA. However, further research is needed, especially a combination of high-quality long-term prospective studies and carefully designed RCTs.
摘要：
背景：孟鲁司特是一种用于治疗哮喘的高度选择性和特异性半胱氨酰白三烯受体拮抗剂。孟鲁司特作为辅助治疗是否可以显著和安全地治疗成人咳嗽变异性哮喘（CVA）仍然没有定论。
目的：本荟萃分析系统评价孟鲁司特辅助治疗成人CVA的疗效和安全性。
方法：孟鲁司特联合吸入性糖皮质激素（ICS）和长效β2激动剂（LABA）治疗成人CVA的随机对照试验（RCT），从成立到2023年3月6日，从CNKI检索，万方,VIP,CBM,PubMed,Embase,科克伦图书馆,和WebofScience数据库和临床试验网站。使用ReviewManager（5.4版）和Stata（15.0版）进行荟萃分析。
结果：共有15项随机对照试验最终纳入meta分析。已确定孟鲁司特作为辅助治疗提高了总有效率(RR=1.20,95%置信区间[CI][1.13,1.27],P<0.01）并提高了FEV1%（SMD=0.91，95%CI[0.40，1.41]，P<0.01),PEF%(SMD=0.63，95%CI[0.38，0.88]，P<0.01),FEV1（SMD=1.15，95%CI[0.53，1.77]，P<0.01),PEF（SMD=0.64，95%CI[0.42，0.86]，P<0.01),和FEV1/FVC%(SMD=0.76，95%CI[0.51，1.01]，P<0.01）并降低复发率（RR=0.28，95％CI[0.15，0.53]，P<0.01)。孟鲁司特辅助组不良反应发生率高于对照组，但差异无统计学意义（RR=1.32，95%CI[0.89，1.96]，P=0.17）。
结论：现有证据表明，使用孟鲁司特作为辅助治疗对成人CVA患者的治疗效果优于单独使用ICS+LABA。然而,需要进一步的研究，特别是高质量的长期前瞻性研究和精心设计的RCT相结合。
目的：本荟萃分析系统评价孟鲁司特辅助治疗成人CVA的疗效和安全性。
方法：孟鲁司特联合吸入性糖皮质激素（ICS）和长效β2激动剂（LABA）治疗成人CVA的随机对照试验（RCT），从成立到2023年3月6日，从CNKI检索，万方,VIP,CBM,PubMed,Embase,科克伦图书馆,和WebofScience数据库和临床试验网站。使用ReviewManager（5.4版）和Stata（15.0版）进行荟萃分析。
结果：共有15项随机对照试验最终纳入meta分析。已确定孟鲁司特作为辅助治疗提高了总有效率(RR=1.20,95%置信区间[CI][1.13,1.27],P<0.01）并提高了FEV1%（SMD=0.91，95%CI[0.40，1.41]，P<0.01),PEF%(SMD=0.63，95%CI[0.38，0.88]，P<0.01),FEV1（SMD=1.15，95%CI[0.53，1.77]，P<0.01),PEF（SMD=0.64，95%CI[0.42，0.86]，P<0.01),和FEV1/FVC%(SMD=0.76，95%CI[0.51，1.01]，P<0.01）并降低复发率（RR=0.28，95％CI[0.15，0.53]，P<0.01)。孟鲁司特辅助组不良反应发生率高于对照组，但差异无统计学意义（RR=1.32，95%CI[0.89，1.96]，P=0.17）。
结论：现有证据表明，使用孟鲁司特作为辅助治疗对成人CVA患者的治疗效果优于单独使用ICS+LABA。然而,需要进一步的研究，特别是高质量的长期前瞻性研究和精心设计的RCT相结合。
