Efficacy of Montelukast in Allergic Rhinitis Treatment: A Systematic Review and Meta-Analysis

• Published in: Drugs (New York, N.Y.) Vol. 80; no. 17; pp. 1831 - 1851
• Main Authors: Krishnamoorthy, Madhusudhan, Mohd Noor, Norhayati, Mat Lazim, Norhafiza, Abdullah, Baharudin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2020; Springer Nature B.V
• Subjects: Allergic rhinitis; Antihistamines; Bias; Clinical trials; Confidence intervals; Corticosteroids; Daytime; Fluticasone; Histamine; Internal Medicine; Medicine; Medicine & Public Health; Meta-analysis; Montelukast; Performance evaluation; Pharmacology/Toxicology; Pharmacotherapy; Placebos; Questionnaires; Reviews; Rhinitis; Rhinoconjunctivitis; Software; Systematic Review
• ISSN: 0012-6667; 1179-1950
• DOI: 10.1007/s40265-020-01406-9

Background
In treating allergic rhinitis, montelukast has the potential to be used as an alternative or addition to an oral antihistamine or intranasal corticosteroid.
Objective
The objective of this systematic review was to assess the effectiveness of montelukast in treating allergic rhinitis.
Methods
An electronic literature search was performed using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from 1966 to 21 January 2019. The eligibility criteria were randomized controlled trials comparing montelukast with placebo or other standard treatments. The primary outcomes assessed were daytime nasal symptom score (DNS) and night-time nasal symptom score (NNS). The secondary outcomes assessed were composite nasal symptom score (CSS), daytime eyes symptom score (DES), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). The meta-analysis was conducted using Review Manager 5.3 software based on the random-effects model.
Results
Fifteen studies of 10387 participants met the inclusion criteria. Montelukast was more effective than placebo in improving DNS (mean difference [MD] − 0.12, 95% confidence interval [CI] − 0.15 to − 0.08;
p
 < 0.001), NNS (MD − 0.09, 95% CI − 0.13 to − 0.05;
p
 < 0.001), CSS (MD − 0.08, 95% CI − 0.11 to − 0.06;
p
 < 0.001), DES (MD − 0.17, 95% CI − 0.33 to − 0.02;
p
 < 0.030), and RQLQ (MD − 0.34, 95% CI − 0.49 to − 0.20;
p
 < 0.001). Oral antihistamine was superior to montelukast in improving DNS (MD 0.08, 95% CI 0.03–0.13;
p
 = 0.002), CSS (MD 0.03, 95% CI − 0.02 to 0.07;
p
 = 0.27), DES (MD 0.06, 95% CI 0–0.12;
p
 = 0.040), and RQLQ (MD 0.03, 95% CI − 0.05 to 0.12;
p
 = 0.430). Montelukast was superior to oral antihistamine in improving NNS (MD -0.03, 95% CI − 0.08 to 0.03;
p
 = 0.330). Intranasal fluticasone spray was superior to montelukast in improving DNS (MD 0.71, 95% CI 0.44–0.99;
p
 < 0.001) and NNS (MD 0.63, 95% CI 0.29–0.97;
p
 < 0.001). Combined montelukast and oral antihistamine was superior to oral antihistamine in improving DNS (MD − 0.15, 95% CI − 0.27 to − 0.03;
p
 = 0.010), NNS (MD − 0.16, 95% CI − 0.28 to − 0.05;
p
 = 0.006), CSS (MD − 0.12, 95% CI − 0.25 to − 0.01;
p
 = 0.070), DES (MD − 0.12, 95% CI − 0.30 to 0.06;
p
 = 0.180), and RQLQ (MD − 0.10, 95% CI − 0.28 to 0.08;
p
 = 0.290). Combined montelukast and OAH was superior to montelukast in improving DNS (MD 0.15, 95% CI 0.08–0.21;
p
 < 0.001), NNS (MD 0.05, 95% CI − 0.09 to 0.19;
p
 = 0.510), CSS (MD 0.1, 95% CI 0.03–0.17;
p
 = 0.007), DES (MD 0.18, 95% CI 0–0.36;
p
 = 0.050), and RQLQ (MD 0.07 95% CI − 0.15 to 0.29;
p
 = 0.530).
Conclusions
Montelukast is more effective than placebo in treating the overall symptoms of allergic rhinitis while the combined therapy of montelukast and an oral antihistamine is superior to either montelukast or an oral antihistamine alone.