Patient Care - Allergy & Immunology - October 2007 - (Page 21)

Allergic rhinitis I TABLE 1 Key clinical trials of newer-generation antihistamines for seasonal allergic rhinitis Study design Fexofenadine (Allegra): Multicenter, placebocontrolled, double-blind trial, 570 patients1 Fexofenadine: Multicenter, placebocontrolled, double-blind trial, 588 patients2 Dosage 60, 120, and 240 mg bid 60 and 120 mg bid Results Significantly improved both total and individual symptom scores at all dosages versus placebo. Significantly improved both reflective daily symptom scores and individual symptom scores at both dosages versus placebo. All dosages significantly reduced total symptom scores versus placebo. Significant improvements in total symptom scores over 2 weeks of treatment during both spring and fall allergy seasons versus placebo. Desloratadine (Clarinex): Placebocontrolled, double-blind trial, 1026 patients3 Desloratadine: Multicenter, randomized, double-blind, placebo-controlled, parallelgroup investigations in patients with seasonal allergic rhinitis conducted during both the spring and fall allergy seasons, 674 patients4 Cetirizine (Zyrtec): 4-way, double-blind, randomized, placebo-controlled trial, 419 patients5 Cetirizine: Randomized, double-blind, placebo-controlled trial, 183 patients6 2.5, 5, 7.5, 10, and 20 mg qd 5 mg qd 5, 10, and 20 mg qd Significantly reduced a number of symptom scores, including sneezing and rhinorrhea versus placebo. Improved a number of individual symptom scores versus placebo. Improvement in total symptom scores in the cetirizine-treated group was not seen. 10 mg qd 1. Bernstein DI, Schoenwetter WF, Nathan RA, et al. Efficacy and safety of fexofenadine hydrochloride for treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 1997;79:443-448. 2. Bronsky EA, Falliers CJ, Kaiser HB, et al. Effectiveness and safety of fexofenadine, a new nonsedating H1-receptor antagonist, in the treatment of fall allergies. Allergy Asthma Proc. 1998;19:135-141. 3. Salmun LM, Lorber R. 24-hour efficacy of once-daily desloratadine therapy in patients with seasonal allergic rhinitis. BMC Fam Pract. 2002;5:14. 4. Meltzer EO, Prenner BM, Nayak A, et al. Efficacy and tolerability of once-daily 5 mg desloratadine, an H1-receptor antagonist, in patients with seasonal allergic rhinitis. Clin Drug Invest. 2001;21:25-32. 5. Falliers CJ, Brandon ML, Buchman E, et al. Double-blind comparison of cetirizine and placebo in the treatment of seasonal rhinitis. Ann Allergy. 1991;66:257-262. 6. Grant JA, Nicodemus CF, Findlay SR, et al. Cetirizine in patients with seasonal rhinitis and concomitant asthma: prospective, randomized, placebocontrolled trial. J Allergy Clin Immunol. 1995;95 (5 pt 1):923-932. How effective is montelukast? For montelukast to be considered a valuable therapeutic option,its clinical efficacy needs to be compared with that of the newer-generation oral antihistamines (see Table 2, page 23). The following randomized, controlled clinical studies compare montelukast with the newer-generation antihistamines, either as monotherapy or in combination. Montelukast monotherapy Two placebo-con- trolled clinical studies compared monotherapy with montelukast or loratadine in more than 2000 patients with seasonal AR during the spring pollen season. In the first study, montelukast and loratadine, both in 10-mg dosages given once daily for 2 weeks, were more effective than placebo at improving daytime nasal symptoms.25 In addition, the symptom relief observed with both medications showed improvements in quality of life, as assessed by the OCTOBER 2007 PATIENT CARE ALLERGY & IMMUNOLOGY 21

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Patient Care - Allergy & Immunology - October 2007 Research Digest Contents Medicine in the News When to Suspect Celiac Disease and How to Proceed From There Averting Angioedema’s Potentially Dire Consequences Is There a Role for Leukotriene Receptor Antagonists in Treating Allergic rhinitis? Clinical Clips Dermatology Case Challenge Classified Advertising

Patient Care - Allergy & Immunology - October 2007

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