Montelukast for toddler asthma? A meta-analysis of montelukast in preschool wheeze

Background Wheeze in the preschool age has a high prevalence and healthcare burden. There is conflicting evidence of the effectiveness of montelukast, a leukotriene receptor antagonist, in preschool wheeze. Recent meta-analyses have focused on its use in viral induced or multiple-trigger wheeze, however such groups are unlikely to exist in real-life and change with time, recently highlighted in an international consensus report. We have therefore sought to investigate the effectiveness of montelukast in all children with preschool wheeze. Methods The PubMed, Cochrane Library, Ovid Medline and Ovid EMBASE were screened for randomised controlled trials (RCTs), examining the efficacy of montelukast compared with placebo in children with the preschool wheeze. Results Five trials containing 3960 patients (6 months to 5 years) with a preschool wheezing disorder were analysed. Meta-analyses of studies of intermittent montelukast, showed no benefit in preventing episodes of wheeze (Mean Difference (MD) 0.07, 95% CI -0.14 to 0.29), reducing unscheduled medical attendances (MD -0.13, 95% CI -0.33 to 0.07) and reducing oral corticosteroid use (MD -0.06, 95% CI -0.16 to 0.02). The pooled results of the continuous regimen showed no significant difference in the number of wheezing episodes between the montelukast and placebo groups (MD -0.40, 95% CI -1.00 to 0.19). Discussion This review highlights that the currently available evidence do not support the routine use of montelukast in children with preschool wheeze. We recommend further studies to investigate if the specific 9montelukast responder9 phenotype exists, and how these can be easily identified in the clinical setting.