Lu Yi, Yin Min, Cheng Lei
Department of Otorhinolaryngology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Department of Otorhinolaryngology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China. Email:
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Aug;49(8):659-67.
To evaluate the treatment outcomes of leukotriene receptor antagonists (LTRA) as monotherapy or combined with the second-generation oral H1-histamines in the treatment of allergic rhinitis (AR), and to provide a basis for optimizing clinical therapeutic strategies.
PubMed,EMBASE, CBMdisc and CJFD databases, retrieving randomized controlled trials (RCTs) of AR therapy literatures were searched. Based on the literature inclusion and exclusion criteria, the related literatures were selected and the quality was evaluated by using the Jadad scale. Meta-analysis was performed by Stata 12.1 software.For continuous outcomes, the weighted mean difference (WMD) and its 95% confidence intervals (CI) were calculated. The forest plots were drawn. The treatment outcomes included daytime nasal symptom scores (DNSS), nighttime symptom scores (NSS), composite symptom scores (CSS), daytime eye symptom scores (DESS), and the rhinoconjunctivitis quality of life questionnaire (RQLQ) were used to evaluate the therapeutic effects of LTRA on seasonal and perennial AR.
Eleven of clinical RCTs including 14 809 cases of AR patients, aged 15 to 85 years old, were available for Meta-analysis. Montelukast, a drug of LTRA, was primarily evaluated in the study. The results of Meta-analysis showed: (1) Compared with the placebo, montelukast statistically significantly reduced the DNSS,NSS, CSS, and RQLQ scores in patients with seasonal and perennial AR, as well as the DESS in patients with seasonal AR.(2) There were no statistical differences in the improvement of the CSS,DESS, and RQLQ scores in patients with seasonal AR after the treatment by montelukast compared with loratadine, a second-generation oral H1-histamine.(3) Montelukast statistically significantly reduced the NSS, but not DNSS, in patients with seasonal AR compared with loratadine.(4) The combination therapy of montelukast and loratadine statistically significantly improved the CSS compared with either montelukast or loratadine monotherapy.
Montelukast, a representative drug of LTRA, can be used as first-line therapy for AR, with comprehensive improvement of the nasal and ocular symptoms and the quality of life in AR patients. Montelukast combined with loratadine can significantly improve the diurnal and nocturnal symptoms for patients with seasonal AR, and the curative effect is better than the single use of montelukast or loratadine.
评估白三烯受体拮抗剂（LTRA）单药治疗或联合第二代口服H1组胺药治疗变应性鼻炎（AR）的疗效，为优化临床治疗策略提供依据。
检索PubMed、EMBASE、CBMdisc和CJFD数据库，检索AR治疗文献的随机对照试验（RCT）。根据文献纳入和排除标准，筛选相关文献，并用Jadad量表进行质量评价。采用Stata 12.1软件进行Meta分析。对于连续性结局，计算加权均数差（WMD）及其95%置信区间（CI）。绘制森林图。采用日间鼻症状评分（DNSS）、夜间症状评分（NSS）、综合症状评分（CSS）、日间眼症状评分（DESS）及变应性鼻炎生活质量问卷（RQLQ）评估LTRA对季节性和常年性AR的治疗效果。
纳入11项临床RCT，共14 809例AR患者，年龄15~85岁，可用于Meta分析。研究主要评估了LTRA类药物孟鲁司特。Meta分析结果显示：（1）与安慰剂相比，孟鲁司特可使季节性和常年性AR患者的DNSS、NSS、CSS及RQLQ评分显著降低，使季节性AR患者的DESS显著降低。（2）孟鲁司特治疗季节性AR患者后，其CSS、DESS及RQLQ评分改善情况与第二代口服H1组胺药氯雷他定相比，差异无统计学意义。（3）与氯雷他定相比，孟鲁司特可使季节性AR患者的NSS显著降低，但不能使DNSS显著降低。（4）孟鲁司特与氯雷他定联合治疗较孟鲁司特或氯雷他定单药治疗能显著改善CSS。
LTRA的代表性药物孟鲁司特可作为AR的一线治疗药物，能全面改善AR患者的鼻眼症状及生活质量。孟鲁司特联合氯雷他定可显著改善季节性AR患者的昼夜症状，疗效优于单用孟鲁司特或氯雷他定。
