Montelukast Was Inefficient in Maintaining Steroid-Induced Remission in Adult Eosinophilic Esophagitis

• Published in: Digestive diseases and sciences Vol. 56; no. 12; pp. 3551 - 3558
• Main Authors: Lucendo, Alfredo J., De Rezende, Livia C., Jiménez-Contreras, Susana, Yagüe-Compadre, Jose Luis, González-Cervera, Jesús, Mota-Huertas, Teresa, Guagnozzi, Danila, Angueira, Teresa, González-Castillo, Sonia, Arias, Ángel
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-12-2011; Springer; Springer Nature B.V
• Subjects: Acetates - administration & dosage; Acetates - therapeutic use; Adult; Adults; Androstadienes - administration & dosage; Androstadienes - therapeutic use; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Biochemistry; Biological and medical sciences; Biopsy; Dose-Response Relationship, Drug; Drug Therapy, Combination; Endoscopy; Endoscopy, Gastrointestinal; Eosinophilic Esophagitis - drug therapy; Eosinophilic Esophagitis - metabolism; Eosinophilic Esophagitis - pathology; Esophagitis; Esophagus; Feeding. Feeding behavior; Female; Fluticasone; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Health aspects; Hepatology; Humans; Leukotriene Antagonists - administration & dosage; Leukotriene Antagonists - therapeutic use; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Montelukast; Oncology; Original Article; Other diseases. Semiology; Patient Satisfaction; Prospective Studies; Quinolines - administration & dosage; Quinolines - therapeutic use; Remission Induction - methods; Surveys and Questionnaires; Topical medication; Transplant Surgery; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Young Adult; Montelukast; Anti-leukotriene; Leukotriene D4; Dysphagia; Eosinophilic esophagitis; Allergic esophagitis; Human; Steroid; Immunopathology; Allergy; Leukotriene receptor; Esophageal disease; Esophagitis; Metabolic diseases; Leukotriene E4; Antiasthma agent; Gastroenterology; Leukotriene antagonist; ENT disease; Digestive diseases; Adult; Remission
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-011-1775-y

Background and Aims
Leukotriene D4 is produced by and functions as a chemotactic factor for eosinophils. Eosinophilic esophagitis (EoE) is characterized by esophageal eosinophilic infiltration, determining structural changes and dismotility symptoms. Montelukast, a selective leukotriene D4 receptor antagonist, has gained increasing consideration as a therapeutic agent for EoE. However, limited available information has shown that montelukast is not effective in reducing eosinophilic infiltration. Our paper aims at evaluating whether montelukast could be consider as a steroid-sparing therapy by assessing its efficacy in maintaining both clinical and histopathological remission achieved after topical corticosteroids in adult EoE patients.
Methods
Eleven consecutively diagnosed adult EoE patients were prospectively studied. Esophageal biopsies were obtained before and after a 6-month treatment with fluticasone propionate 400 μg/twice a day. Immediately after that, montelukast 10 mg/day was instituted. A new endoscopy was foreseen after a new 3-month period, or as soon as the patients presented esophageal symptoms. Symptoms were assessed by using a questionnaire before and after fluticasone propionate treatment and after montelukast therapy.
Results
Eosinophils density into the esophageal epithelium and lamina propria was significantly reduced after a 6-month treatment with topical steroids (
P
= 0.003) and increased to levels similar to baseline level into the first 3 months after treatment with montelukast. Baseline symptom scores significantly decreased after treatment with topical steroids (
P
= 0.003) and increased again after montelukast therapy, but baseline levels improved.
Conclusions
Montelukast was not efficient in maintaining the histopathological or clinical response achieved by topical steroids in adult EoE patients.