A placebo-controlled, dose-ranging study of montelukast, a cysteinyl leukotriene–receptor antagonist☆☆☆★★★♢

Abstract Background: The cysteinyl leukotrienes are important mediators of bronchial asthma. The clinical effect of montelukast, a potent cysteinyl leukotriene–receptor antagonist, was investigated in a randomized, placebo-controlled, multicenter, parallel-group, dose-ranging study. Methods: After a 3-week, single-blind, placebo run-in period, 343 asthmatic patients (FEV 1 40% to 80% of the predicted value with an improvement in FEV 1 of at least 15% [absolute value] after receiving inhaled β-agonists on at least two occasions) were randomly assigned to one of six treatment groups: placebo; 10, 100, or 200 mg once daily montelukast in the evening; or 10 or 50 mg twice daily montelukast for a 6-week, double-blind treatment period followed by a 1-week placebo washout period. All patients used inhaled, short-acting β-agonists as needed. Results: All montelukast doses caused similar and significant differences compared with placebo in asthma control endpoints. The least-square mean difference between pooled montelukast groups and placebo in the percentage change from baseline in morning FEV 1 (10.30%; 95% CI: 5.56 to 15.04), as-needed β-agonist use (–0.98 puffs; 95% CI: –1.53 to –0.44), morning peak expiratory flow rate (18.80 L/min; 95% CI: 8.62 to 28.98), physicians' and patients' global evaluations, and asthma-specific quality-of-life scores were all significant ( p ≤ 0.050). The incidence of adverse experiences was not dose related and was similar between placebo and montelukast treatment. Conclusion: Montelukast caused a significant improvement in chronic asthma at an oral, once daily evening dose as low as 10 mg. (J Allergy Clin Immunol 1998;102:50-6.)