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Inhaled Corticosteroids versus Leukotriene Antagonists as First-Line Therapy for Asthma

A Systematic Review of Current Evidence

  • Original Research Article
  • Published:
Treatments in Respiratory Medicine

Abstract

Inhaled corticosteroids are the most effective anti-inflammatory drugs for asthma. Leukotriene receptor antagonists are a new class of anti-inflammatory drugs that have the advantage of oral administration and the potential for better compliance compared with inhaled corticosteroids.

This article summarizes evidence from randomized controlled trials, comparing the efficacy and tolerability of inhaled corticosteroids with those of leukotriene receptor antagonists in patients with persistent asthma.

The evidence derived from a systematic review of randomized controlled trials confirms that patients treated with inhaled corticosteroids of chlorofluorocarbon-propelled beclomethasone 400 µg/day or fluticasone propionate 200 µg/day have better asthma control than those treated with oral leukotriene receptor antagonists. More specifically, treatment with inhaled corticosteroids is associated with 65% fewer exacerbations requiring systemic corticosteroids, greater improvement in spirometry and symptoms, fewer night-time awakenings and less use of rescue β2-adrenoceptor agonists.

This review does not identify any difference in short-term safety between inhaled corticosteroids and leukotriene receptor antagonists. Although adverse effects typically associated with inhaled corticosteroids (such as growth suppression, osteopenia, and adrenal suppression) were not measured, preventing a fair comparison of the safety profile on long-term use.

In conclusion, the scientific evidence does not support the substitution of leukotriene receptor antagonists for low doses of inhaled corticosteroids, which should remain first-line therapy for asthma control.

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Acknowledgment

I wish to thank Franco Di Salvio and Giselle Hicks for their participation in the assessment of methodology and data extraction, and diligent data entry. I am indebted to the following individuals who replied to my request for confirmation of methodology and data extraction, and who graciously provided additional data, whenever possible: Christopher Miller and Susan Shaffer from AstraZeneca, USA; Ian Naya and Roger Metcalf for AstraZeneca, Sweden; Theodore F. Reiss and G.P. Noonan from Merck Frosst, USA; Frank Kanniess from the Pulmonary Research Institute, Germany; and Graziano Riccioni, Italy. I am indebted to the Cochrane Airways Review Group, namely Toby Lasserson and Karen Blackhall, for the literature search and ongoing support, and to Paul Jones and Christopher Cates for their constructive comments.

FM Ducharme is supported by a National Researcher Award of the Fonds de la Recherche en Santé du Québec. No research funding was available for the review.

FM Ducharme has received travel support, research funds and fees for speaking from AstraZeneca Inc., producer of zafirlukast, Merck Frosst Inc., producer of montelukast, and GlaxoSmithKline Inc., producer of inhaled glucocorticoid preparations with which leukotriene receptor antagonists were compared.

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Authors and Affiliations

  1. Departments of Paediatrics and of Epidemiology & Biostatistics, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada

    Francine M. Ducharme (Associate Professor)

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  1. Francine M. Ducharme
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Correspondence to Francine M. Ducharme.

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Ducharme, F.M. Inhaled Corticosteroids versus Leukotriene Antagonists as First-Line Therapy for Asthma. Treat Respir Med 3, 399–405 (2004). https://doi.org/10.2165/00151829-200403060-00006

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  • DOI: https://doi.org/10.2165/00151829-200403060-00006

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