[Meta-analysis of leukotriene receptor antagonist montelukast in the treatment of allergic rhinitis].

OBJECTIVE: To evaluate the treatment outcomes of leukotriene receptor antagonists (LTRA) as monotherapy or combined with the second-generation oral H1-histamines in the treatment of allergic rhinitis (AR), and to provide a basis for optimizing clinical therapeutic strategies.

METHODS: PubMed,EMBASE, CBMdisc and CJFD databases, retrieving randomized controlled trials (RCTs) of AR therapy literatures were searched. Based on the literature inclusion and exclusion criteria, the related literatures were selected and the quality was evaluated by using the Jadad scale. Meta-analysis was performed by Stata 12.1 software.For continuous outcomes, the weighted mean difference (WMD) and its 95% confidence intervals (CI) were calculated. The forest plots were drawn. The treatment outcomes included daytime nasal symptom scores (DNSS), nighttime symptom scores (NSS), composite symptom scores (CSS), daytime eye symptom scores (DESS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) were used to evaluate the therapeutic effects of LTRA on seasonal and perennial AR.

RESULTS: Eleven of clinical RCTs including 14 809 cases of AR patients, aged 15 to 85 years old, were available for Meta-analysis. Montelukast, a drug of LTRA, was primarily evaluated in the study. The results of Meta-analysis showed: (1) Compared with the placebo, montelukast statistically significantly reduced the DNSS,NSS, CSS, and RQLQ scores in patients with seasonal and perennial AR, as well as the DESS in patients with seasonal AR.(2) There were no statistical differences in the improvement of the CSS,DESS, and RQLQ scores in patients with seasonal AR after the treatment by montelukast compared with loratadine, a second-generation oral H1-histamine.(3) Montelukast statistically significantly reduced the NSS, but not DNSS, in patients with seasonal AR compared with loratadine.(4) The combination therapy of montelukast and loratadine statistically significantly improved the CSS compared with either montelukast or loratadine monotherapy.

CONCLUSIONS: Montelukast, a representative drug of LTRA, can be used as first-line therapy for AR, with comprehensive improvement of the nasal and ocular symptoms and the quality of life in AR patients. Montelukast combined with loratadine can significantly improve the diurnal and nocturnal symptoms for patients with seasonal AR, and the curative effect is better than the single use of montelukast or loratadine.