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Efficacy of Montelukast in Allergic Rhinitis Treatment: A Systematic Review and Meta-Analysis

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Abstract

Background

In treating allergic rhinitis, montelukast has the potential to be used as an alternative or addition to an oral antihistamine or intranasal corticosteroid.

Objective

The objective of this systematic review was to assess the effectiveness of montelukast in treating allergic rhinitis.

Methods

An electronic literature search was performed using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from 1966 to 21 January 2019. The eligibility criteria were randomized controlled trials comparing montelukast with placebo or other standard treatments. The primary outcomes assessed were daytime nasal symptom score (DNS) and night-time nasal symptom score (NNS). The secondary outcomes assessed were composite nasal symptom score (CSS), daytime eyes symptom score (DES), and rhinoconjunctivitis quality-of-life questionnaires (RQLQ). The meta-analysis was conducted using Review Manager 5.3 software based on the random-effects model.

Results

Fifteen studies of 10387 participants met the inclusion criteria. Montelukast was more effective than placebo in improving DNS (mean difference [MD] − 0.12, 95% confidence interval [CI] − 0.15 to − 0.08; p < 0.001), NNS (MD − 0.09, 95% CI − 0.13 to − 0.05; p < 0.001), CSS (MD − 0.08, 95% CI − 0.11 to − 0.06; p < 0.001), DES (MD − 0.17, 95% CI − 0.33 to − 0.02; p < 0.030), and RQLQ (MD − 0.34, 95% CI − 0.49 to − 0.20; p < 0.001). Oral antihistamine was superior to montelukast in improving DNS (MD 0.08, 95% CI 0.03–0.13; p = 0.002), CSS (MD 0.03, 95% CI − 0.02 to 0.07; p = 0.27), DES (MD 0.06, 95% CI 0–0.12; p = 0.040), and RQLQ (MD 0.03, 95% CI − 0.05 to 0.12; p = 0.430). Montelukast was superior to oral antihistamine in improving NNS (MD -0.03, 95% CI − 0.08 to 0.03; p = 0.330). Intranasal fluticasone spray was superior to montelukast in improving DNS (MD 0.71, 95% CI 0.44–0.99; p < 0.001) and NNS (MD 0.63, 95% CI 0.29–0.97; p < 0.001). Combined montelukast and oral antihistamine was superior to oral antihistamine in improving DNS (MD − 0.15, 95% CI − 0.27 to − 0.03; p = 0.010), NNS (MD − 0.16, 95% CI − 0.28 to − 0.05; p = 0.006), CSS (MD − 0.12, 95% CI − 0.25 to − 0.01; p = 0.070), DES (MD − 0.12, 95% CI − 0.30 to 0.06; p = 0.180), and RQLQ (MD − 0.10, 95% CI − 0.28 to 0.08; p = 0.290). Combined montelukast and OAH was superior to montelukast in improving DNS (MD 0.15, 95% CI 0.08–0.21; p < 0.001), NNS (MD 0.05, 95% CI − 0.09 to 0.19; p = 0.510), CSS (MD 0.1, 95% CI 0.03–0.17; p = 0.007), DES (MD 0.18, 95% CI 0–0.36; p = 0.050), and RQLQ (MD 0.07 95% CI − 0.15 to 0.29; p = 0.530).

Conclusions

Montelukast is more effective than placebo in treating the overall symptoms of allergic rhinitis while the combined therapy of montelukast and an oral antihistamine is superior to either montelukast or an oral antihistamine alone.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia

    Madhusudhan Krishnamoorthy, Norhafiza Mat Lazim & Baharudin Abdullah

  2. Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia

    Norhayati Mohd Noor

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  1. Madhusudhan Krishnamoorthy
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Correspondence to Baharudin Abdullah.

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No funding was received for the preparation of this article.

Conflict of Interest

Madhusudhan Krishnamoorthy, Norhayati Mohd Noor, Norhafiza Mat Lazim, and Baharudin Abdullah have no conflicts of interest that are directly relevant to the content of this article.

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Availability of Data and Material

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Author Contributions

MK: conception, development of the protocol, study selection, data extraction, assessment of the risk of bias, data analysis and interpretation, manuscript preparation, critical review, final approval. NMN: conception, development of the protocol, study selection, data extraction, assessment of the risk of bias, data analysis and interpretation, manuscript preparation, critical review, final approval. NML: conception, development of the protocol, study selection, data extraction, assessment of the risk of bias, data analysis and interpretation, manuscript preparation, critical review, final approval. BA: conception, development of the protocol, study selection, data extraction, assessment of risk of the bias, data analysis and interpretation, manuscript preparation, critical review, final approval.

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Krishnamoorthy, M., Mohd Noor, N., Mat Lazim, N. et al. Efficacy of Montelukast in Allergic Rhinitis Treatment: A Systematic Review and Meta-Analysis. Drugs 80, 1831–1851 (2020). https://doi.org/10.1007/s40265-020-01406-9

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