Are LTRAs an Effective Option for Asthma Monotherapy?

A new systematic review and meta-analysis finds that leukotriene-receptor antagonists (LTRAs) as monotherapy improved asthma control, although which patients are most likely to respond to treatment with LTRAs remains unclear.

In an effort to determine the benefits and harms of LTRAs as monotherapy or in combination with inhaled corticosteroids compared with placebo in adults and adolescents with asthma, a team including researchers from the University of Thessaly School of Medicine in Larissa, Greece examined data from 50 randomized trials. In the trials, nearly 10,000 patients were assigned to receive an LTRA—either alone or combined with inhaled corticosteroids—or a placebo.

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Overall, those receiving LTRA monotherapy demonstrated a 40% reduction in risk for asthma exacerbations, according to the authors, who note that LTRA add-on therapy was not linked to a significant risk reduction. LTRA monotherapy also improved other measures of asthma control more consistently than did add-on therapy. Adverse event rates were similar in both patient groups.

Successful long-term management of asthma includes the use of medications “that target the underlying inflammatory process,” says Michael Miligkos, MD, MS, of the laboratory of biomathematics at the University of Thessaly School of Medicine, and lead study author.

Inhaled corticosteroids (ICSs), he says, are “the gold standard of maintenance treatment, i.e., medications taken on a regular basis to control asthma symptoms.

LTRAs, however, have the advantages of oral administration, which may increase adherence and is “obviously not dependent on proper inhalation technique and apparent avoidance of the adverse effects associated with long-term corticosteroid therapy,” says Miligkos.

Ultimately, these findings suggest that “LTRAs may be efficacious and safe either as an alternative treatment in adult and adolescent patients who cannot or prefer not to take ICSs, or as add-on treatment in patients with concomitant ICS use,” says Miligkos.

“Therefore, primary care physicians may identify patients with specific disease characteristics (asthma phenotypes) who may respond well to LTRAs, such as patients with mild asthma and concurrent allergic rhinitis, and provide them with all the available evidence to make an informed decision for their therapy,” he adds, concluding that physicians should still “closely assess and monitor asthma control, and adjust the treatment regimen if needed.”

—Mark McGraw


Miligkos M, Bannuru R, et al. Leukotriene-Receptor Antagonists Versus Placebo in the Treatment of Asthma in Adults and Adolescents: A Systematic Review and Meta-Analysis. Ann Intern Med. 2015.