Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Arch Dis Child. 2010 May;95(5):365-70. doi: 10.1136/adc.2009.169177. Epub 2009 Nov 27.
To compare the efficacy of inhaled corticosteroids (ICS) versus montelukast (MONT) in schoolchildren and adolescents with mild-moderate persistent asthma.
Randomised, prospective, controlled trials published January 1996 to November 2009 with a minimum of 4 weeks of ICS versus MONT and of ICS versus MONT+ICS were retrieved through Medline, Embase and Central databases. The primary outcome was asthma exacerbations requiring systemic corticosteroids (AEX); secondary outcomes were pulmonary function, withdrawal/hospitalisation due to AEX, change in symptoms score, rescue-medication-free days, albuterol use, adverse effects and adherence.
Of 124 studies identified, 18 studies (n=3757 patients) met criteria for inclusion (13 compared ICS vs MONT, 3 ICS vs MONT+ICS and 2 ICS vs MONT vs ICS+MONT). Patients receiving ICS showed a significantly lower risk for AEX than those with MONT (RR=0.83, 95% CI 0.72 to 0.96, p=0.01); post-hoc analysis suggests this effect was independent of quality, sponsorship and study duration. Children treated with ICS had a significant higher pulmonary function (final FEV1 % predicted, change from baseline FEV1 %, final morning peak expiratory flow (PEF)) and better clinical parameters (albuterol use, symptom score, rescue-medication-free days, withdrawals due to AEX) versus MONT. No significant difference in primary or secondary outcomes was found when MONT was added on to ICS versus ICS alone; however, these analyses were based on only two studies.
Schoolchildren and adolescents with mild-moderate persistent asthma treated with ICS had less AEX and better lung function and asthma control than with MONT. There are insufficient data to determine whether the addition of MONT to ICS improves outcome.
比较吸入性皮质类固醇（ICS）与孟鲁司特（MONT）在轻中度持续性哮喘患儿和青少年中的疗效。
检索 1996 年 1 月至 2009 年 11 月发表的随机、前瞻性、对照试验，ICS 与 MONT 比较，ICS 与 MONT+ICS 比较的时间均至少为 4 周。主要结局为需要全身皮质类固醇治疗的哮喘加重（AEX）；次要结局为肺功能、因 AEX 退出/住院、症状评分变化、无急救药物天数、沙丁胺醇使用、不良反应和依从性。
共确定 124 项研究，其中 18 项研究（n=3757 例患者）符合纳入标准（13 项比较 ICS 与 MONT，3 项 ICS 与 MONT+ICS，2 项 ICS 与 MONT 与 ICS+MONT）。接受 ICS 治疗的患者 AEX 风险显著低于 MONT 组（RR=0.83，95%CI 0.72 至 0.96，p=0.01）；事后分析表明，这种效果与质量、赞助和研究持续时间无关。与 MONT 相比，接受 ICS 治疗的儿童肺功能（末次 FEV1 预计值、FEV1 自基线的变化、末次清晨呼气峰流量（PEF））显著改善，临床参数（沙丁胺醇使用、症状评分、无急救药物天数、因 AEX 退出）也显著改善。与 ICS 相比，当 MONT 加用至 ICS 时，主要或次要结局无显著差异；然而，这些分析仅基于两项研究。
轻中度持续性哮喘患儿和青少年接受 ICS 治疗，AEX 发生率较低，肺功能和哮喘控制情况优于 MONT。尚无足够数据确定将 MONT 加用至 ICS 是否可改善结局。
