Patient Care - Allergy & Immunology - October 2007 - (Page 22)

I Allergic rhinitis Drugs mentioned in this article Beclomethasone dipropionate Cetirizine (Zyrtec) Desloratadine (Clarinex) Fexofenadine (Allegra) Levocitirizine (Airitis) Loratadine Montelukast (Singulair) Pranlukast (Ultair) Zafirlukast (Accolate) Rhinoconjunctivitis Quality of Life Questionnaire. Similar observations were reported in the second monotherapy study. Montelukast and loratadine, both in 10-mg dosages and both given once daily for 2 weeks, were significantly more effective at improving daytime nasal symptom scores than placebo.26 Based on its mechanism of action, montelukast relieved nasal congestion, whereas loratadine did not. Based on the equal efficacy in that large clinical study, it appears that montelukast monotherapy is approximately equivalent to loratadine. In the 2 studies, montelukast was well tolerated and showed a safety profile comparable with that of placebo. Antihistamine-montelukast combination therapy Based on their mechanisms of action, one might expect that antagonizing both histamine and leukotriene receptors would be more effective than monotherapy with either agent. The effects of combining montelukast with the newer-generation antihistamines have been examined in several placebocontrolled clinical studies. In one study, 460 seasonal AR patients were randomized to receive 1 of 5 treatments, once daily in the evening for 2 weeks: montelukast, 10 mg; montelukast, 20 mg; loratadine, 10 mg; montelukast, 10 mg, plus loratadine, 10 mg (loratadine-montelukast combination); placebo.27 Monotherapy with either montelukast or loratadine was not significantly different from placebo at improving the daytime total nasal symptom score. In contrast, the combination of montelukast and loratadine was more effective than placebo or either agent alone. Significantly greater improvements in the individual symptom scores for nasal congestion, rhinorrhea, itching, and sneezing were observed with the combination of montelukast and loratadine compared with placebo or either agent alone. However, the improvement in nasal congestion reported with the montelukast and loratadine combination was not significantly different from that reported with montelukast, 10 mg once daily for 2 weeks. Monotherapy with montelukast, 20 mg, did not provide greater symptom improvement than the agent at 10 mg once daily for 2 weeks. Thus, neither loratadine nor montelukast alone was better than placebo in this study, and improvement was only seen when agents were combined. All treatments including placebo were similarly well tolerated. In another study, 907 patients with seasonal AR were randomized to receive 1 of 4 treatments, once daily at bedtime for 2 weeks: montelukast, 10 mg; loratadine, 10 mg; loratadine-montelukast combination; and placebo.28 When compared with placebo, relief of the daytime total nasal symptom score was significantly greater for the montelukast, loratadine, and the montelukast-loratadine combination treatment groups. However, the montelukast-loratadine combination did not produce significantly greater improvements in the daytime total nasal symptom score compared with montelukast or loratadine monotherapy. All active treatments demonstrated a safety profile comparable to placebo. That study suggests that each agent alone provided a level of efficacy similar to that of the combination. A third study compared the following 3 therapies, once daily for 2 weeks in 37 patients with seasonal AR: fexofenadine, 120 mg; loratadine-montelukast combination; placebo.29 The study showed that the montelukast-loratadine combination did not exhibit greater efficacy than fexofenadine alone at improving nasal peak flow and controlling the symptoms of seasonal AR. More recently, the therapeutic benefits of combining montelukast, 10 mg once daily for 2 weeks, and cetirizine, 10 mg once daily for 2 weeks, were compared with those of cetirizine, 10 mg, alone in the prophylactic treatment of 60 patients with seasonal AR.30 The authors concluded that the montelukast-cetirizine combination pretreatment was more effective than cetirizine alone in preventing ocular and nasal itching and rhinorrhea. Continued on page 24 www.patientcareonline.com 22 PATIENT CARE ALLERGY & IMMUNOLOGY http://www.patientcareonline.com

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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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