Montelukast was inefficient in maintaining steroid-induced remission in adult eosinophilic esophagitis.

Abstract

BACKGROUND AND AIMS:

Leukotriene D4 is produced by and functions as a chemotactic factor for eosinophils. Eosinophilic esophagitis (EoE) is characterized by esophageal eosinophilic infiltration, determining structural changes and dismotility symptoms. Montelukast, a selective leukotriene D4 receptor antagonist, has gained increasing consideration as a therapeutic agent for EoE. However, limited available information has shown that montelukast is not effective in reducing eosinophilic infiltration. Our paper aims at evaluating whether montelukast could be consider as a steroid-sparing therapy by assessing its efficacy in maintaining both clinical and histopathological remission achieved after topical corticosteroids in adult EoE patients.

METHODS:

Eleven consecutively diagnosed adult EoE patients were prospectively studied. Esophageal biopsies were obtained before and after a 6-month treatment with fluticasone propionate 400 μg/twice a day. Immediately after that, montelukast 10 mg/day was instituted. A new endoscopy was foreseen after a new 3-month period, or as soon as the patients presented esophageal symptoms. Symptoms were assessed by using a questionnaire before and after fluticasone propionate treatment and after montelukast therapy.

RESULTS:

Eosinophils density into the esophageal epithelium and lamina propria was significantly reduced after a 6-month treatment with topical steroids (P = 0.003) and increased to levels similar to baseline level into the first 3 months after treatment with montelukast. Baseline symptom scores significantly decreased after treatment with topical steroids (P = 0.003) and increased again after montelukast therapy, but baseline levels improved.

CONCLUSIONS:

Montelukast was not efficient in maintaining the histopathological or clinical response achieved by topical steroids in adult EoE patients.

• Authors: Alfredo J Lucendo, Livia C De Rezende, Susana Jiménez-Contreras, Jose Luis Yagüe-Compadre, Jesús González-Cervera, Teresa Mota-Huertas, Danila Guagnozzi, Teresa Angueira, Sonia González-Castillo, Angel Arias
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 56 Issue 12 Pg. 3551-8 (Dec 2011) ISSN: 1573-2568 [Electronic] United States
• PMID: 21674173 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Acetates
• Androstadienes
• Anti-Inflammatory Agents
• Cyclopropanes
• Leukotriene Antagonists
• Quinolines
• Sulfides
• Fluticasone
• montelukast

Topics

• Acetates (administration & dosage, therapeutic use)
• Adult
• Androstadienes (administration & dosage, therapeutic use)
• Anti-Inflammatory Agents (administration & dosage, therapeutic use)
• Biopsy
• Cyclopropanes
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Endoscopy, Gastrointestinal
• Eosinophilic Esophagitis (drug therapy, metabolism, pathology)
• Female
• Fluticasone
• Follow-Up Studies
• Humans
• Leukotriene Antagonists (administration & dosage, therapeutic use)
• Male
• Middle Aged
• Patient Satisfaction
• Prospective Studies
• Quinolines (administration & dosage, therapeutic use)
• Remission Induction (methods)
• Sulfides
• Surveys and Questionnaires
• Treatment Outcome
• Young Adult