December 9, 2009 — 根據一項線上發表於11月27日兒童疾病學誌（Archives of Disease in Childhood）廣泛性綜合分析的研究結果，吸入型類固醇（ICS）使用於兒童與青少年氣喘可能比montelukast（MONT）好。
智利Catolica de Pontificia大學醫學院的Jose A. Castro-Rodriguez醫師以及烏拉圭Armadas de las Fuerzas醫院中心的Montevideo Gustavo J. Rodrigo醫師寫到，氣喘是世界各地兒童最常見的慢性疾病。目前國際上所有的治療指引建議使用低劑量（beclomethasone 200-400 mcg[BDP]或相對應藥物）為偏好的控制治療，而白三烯素受體拮抗劑（LTRA）為替代療法，用於處理兒童（年齡介於5~11歲）以及青少年的持續性氣喘。這項系統性綜論的目的在於比較ICS相較於MONT（世界各地兒童最常使用的LTRA），以及與MONT加上ICS比較，使用於持續性氣喘學齡兒童與青少年的療效。
Inhaled Corticosteroids May Be Superior to Montelukast in Children With Asthma
By Laurie Barclay, MD
Medscape Medical News
December 9, 2009 — Inhaled corticosteroids (ICSs) may be superior to montelukast (MONT) in children and adolescents with asthma, according to the results of an extensive meta-analysis reported in the November 27 online issue of the Archives of Disease in Childhood.
"Asthma is one of the most common chronic diseases in children worldwide," write Jose A. Castro-Rodriguez, MD, PhD, from the School of Medicine, Pontificia Universidad Catolica de Chile, and Gustavo J. Rodrigo, MD, from Hospital Central de las Fuerzas Armadas in Montevideo, Uruguay. "All current international guidelines recommend the use of low-dose (200-400 mcg of beclomethasone [BDP] or equivalent) [ICS] as the preferred controller therapy, with leukotriene receptor antagonist (LTRA) as an alternative, for the management of persistent asthma in children (5-11 years of age) and adolescents.... The objective of this systematic review is to compare the efficacy of ICS vs. [MONT] (the most common LTRA use in children worldwide) and vs. MONT add-on to ICS in schoolchildren and adolescents with persistent asthma."
A search of Medline, Embase, and Central databases identified randomized, prospective, controlled trials published from January 1996 to November 2009. Inclusion criteria were a minimum of 4 weeks of ICS vs MONT and of ICS vs MONT+ICS, with primary outcome of asthma exacerbations requiring systemic corticosteroids (AEX). Secondary outcomes were pulmonary function, study withdrawal or hospitalization because of AEX, change in symptoms score, rescue-medication-free days, albuterol use, adverse effects, and adherence.
Inclusion criteria were met in 18 of 124 studies identified. Of these 18 studies, which enrolled a total of 3757 patients, 13 compared ICS vs MONT, 3 compared ICS vs MONT+ICS, and 2 compared ICS vs MONT vs ICS+MONT.
Compared with patients receiving MONT, those receiving an ICS had a significantly decreased risk for AEX (relative risk [RR], .83; 95% confidence interval [CI], .72 - .96; P = .01). This finding appeared to be independent of study quality, sponsorship, and study duration, based on post hoc analysis. Children treated with an ICS also fared better than those treated with MONT in terms of pulmonary function (final forced expiratory volume in 1 second [FEV1] % predicted, change from baseline FEV1 %, final morning PEF) and clinical parameters (albuterol use, symptom score, rescue medication-free days, and study withdrawals resulting from AEX).
In 2 studies comparing MONT as add-on therapy to ICS vs ICS alone, there was no significant difference in primary or secondary outcomes.
"Schoolchildren and adolescents with mild-persistent asthma treated with ICS had less AEX and better lung function and asthma control than with MONT," the review authors write. "There is insufficient data to determine if the addition of MONT to ICS improves outcome."
Limitations of this review are that the analysis of the main outcome was based on only 7 studies (representing 65% of the total sample) and that stratification of studies based on different relevant factors was not always possible.
This review received no funding. Dr. Castro-Rodriguez has received lecturing and consultancy fees from Merck Sharp & Dohme, GlaxoSmithKline, and Grunenthal. Dr. Rodrigo has participated as a lecturer and speaker in scientific meetings and courses under the sponsorship of Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Dr. Esteve SA, and Merck Sharp & Dome. He also received honoraria as consultant for CYDEX Inc and Discovery Laboratories.
Arch Dis Child. Published online November 27, 2009.
