Comparison of leukotriene receptor antagonists in addition to inhaled corticosteroid and inhaled corticosteroid alone in the treatment of adolescents and adults with bronchial asthma: a meta-analysis

Background: Leukotriene receptor antagonists (LTRA) have been recommended as treatment for persistent asthma. It is not clear whether oral LTRA in combination with inhaled corticosteroids (ICS) confers any additional benefit over ICS alone. Objective: This meta-analysis was conducted to review the evidence for the benefits and risks of ICS-LTRA in comparison to ICS alone in bronchial asthma. Methods: MEDLIINE, EMBASE, LILACS, and CINAHL databases were searched for studies published through Aug 20, 2011. Studies comparing ICS-LTRA and ICS and those comparing ICS-LTRA and high-dose ICS were examined separately. Studies were pooled to yield odds ratios (ORs) or weighted mean differences (VSTMDs) with 95% confidence intervals (CIs). Results: Eight trials in which ICS-LTRA was compared with the same dose of ICS and five in which ICS-LTRA was compared with high-dose ICS were identified. In adults with mild to moderate asthma, the combination of ICS-LTRA improves the control of asthma when compared with same dose of ICS as monotherapy. The effects of ICS-LTRA therapy are similar to those of high-dose ICS in asthma control, but highdose ICS is superior to ICS-LTRA with regard to improvement in some pulmonary function indices. Conclusions: In adults with mild to moderate asthma, though the effects were minimal, the combination of ICS-LTRA is recommended, when comparing its effects with the same dose ICS as monotherapy. The relative merits of ICSLTRA and high-dose ICS therapy are uncertain and more research is needed.