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International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 963–976 | Cite as

A systematic review on the off-label use of montelukast in atopic dermatitis treatment

  • Weng Khong ChinEmail author
  • Shaun Wen Huey Lee
Review Article
  • 211 Downloads

Abstract

Background Atopic dermatitis (AD) is the most common form of eczema. As leukotriene mediators are involved in the inflammatory phase of atopic dermatitis, montelukast has been suggested as a possible therapy. Aim of the review To evaluate the safety and efficacy of montelukast off-label use for the treatment atopic dermatitis. Method A search was performed from database inception until March 2018 in six electronic databases for randomized-controlled-trials examining the use of montelukast for AD. Results Among 301 articles screened, 11 studies met the inclusion criteria and were included in the review. The study populations consist of paediatric and adult subjects with moderate-to-severe AD. Montelukast use was shown to improve symptoms such as pruritus in four studies. Another 2 studies reported that montelukast could improve symptoms similar to the standard regimen of topical steroid and oral antihistamine. However, five studies reported that montelukast had no effects in symptoms alleviation. The use of montelukast was associated with a similar safety profile to placebo and well-tolerated with minimal adverse effects. Conclusion There is limited evidence to suggest that the off-label use of montelukast is effective in treating moderate-to-severe AD. Further research with larger study populations employing standardized endpoint measuring instrument is warranted to further investigate the off-label use of montelukast in AD treatment. Until then, the use of conventional treatments including optimal daily skin hydration should remain the mainstay in the management of atopic dermatitis. In fact, for moderate-to-severe condition, steroid sparing immune-suppressants should still be used clinically until more effective and safer alternative is discovered.

Keywords

Atopic dermatitis Eczema Leukotriene receptor antagonists Montelukast Off-label use Systemic therapy 

Abbreviations

AD

Atopic dermatitis

RCTs

Randomized rontrolled trials

LTRA

Cysteinyl-leukotriene-1 receptor antagonist

IgE

Immunoglobulin E

LTs

Leukotrienes

SCORAD

Severity Scoring of Atopic Dermatitis

SASSAD

Six Area, Six Sign Atopic Dermatitis

EASI

Eczema Area and Severity Index

ADASI

Atopic Dermatitis Area and Severity Index

IGA

Investigators’ Global Assessment

LTE4

Leukotriene E4

EDN/EPX

Eosinophil-derived neurotoxin/eosinophilic protein X

ECP

Eosinophilic cationic protein

QoL

Quality of life

CDLQI

Children’s Dermatology Life Quality Index

CBC

Complete blood count

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Conflicts of interest

Both authors declare that they have no conflict of interest.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PharmacyMonash University MalaysiaSubang JayaMalaysia
  2. 2.Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Global Asia in the 21st Century (GA21) PlatformMonash University MalaysiaSubang JayaMalaysia

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