Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients
Rj. Dockhorn et al., Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients, THORAX, 55(4), 2000, pp. 260-265
Background-Montelukast, a leukotriene receptor antagonist, improves paramet
ers of asthma control including forced expiratory volume in one second (FEV
1,) when given orally to patients aged six years or older. This study was u
ndertaken to compare the effect on FEV1 of intravenous and oral montelukast
and placebo during the 24 hour period following administration.
Methods-Fifty one asthmatic patients (FEV1 40-80% predicted and greater tha
n or equal to 15% improvement after inhaled beta agonist) were enrolled in
a double blind, single dose, three period, crossover study to receive intra
venous montelukast (7 mg), oral montelukast (10 mg), or placebo in a random
ised fashion. The primary end point was area under the curve (AUG)(0-24 h)
of the percentage change from baseline in FEV1. Additional end points were
maximum percentage change in FEV1 and percentage change at different time p
oints.
Results-Compared with placebo, intravenous and oral montelukast significant
ly increased the AUG(0-24 h) (means of 20.70%, 15.72%, and 7.75% for intrav
enous, oral and placebo, respectively; no statistical difference between in
travenous and oral). The difference in least square means from placebo for
intravenous montelukast was 13.27% (95% CI 7.07 to 19.46), p<0.001 and for
oral montelukast was 7.44% (95% CI 1.20 to 13.68), p = 0.020. The maximum p
ercentage change in FEV1 was nor significantly different for intravenous an
d oral montelukast (difference in least square means 6.78% (95% CI-0.59 to
14.15), p 0.071). The mean percentage change in FEV1 for intravenous montel
ukast was greater than for oral montelukast within the first hour (15.02% v
s 4.67% at 15 min, p less than or equal to 0.001; 18.43% vs 12.90% at one h
our, p<0.001 for intravenous and oral montelukast, respectively (placebo 3.
05% at 15 minutes, 7.33% at one hour). Intravenous and oral montelukast wer
e similar to placebo in the frequency of adverse events,
Conclusions-The onset of action for intravenous montelukast was faster than
for oral montelukast and the improvement in airway function lasted over th
e 24 hour observation period for both treatments. Although not well underst
ood, there was a trend toward a greater improvement: in FEV1 with intraveno
us than with oral montelukast. These findings suggest. that leukotriene rec
eptor antagonists should be investigated as a treatment for acute severe as
thma.