Data from the emerging clinical trials with compounds such as
zileuton,
ICI 204,219,
Bay X1005, MK571, MK679, and MK591 are demonstrating the importance of the
leukotrienes as mediators of
asthma and possibly other diseases such as
rheumatoid arthritis,
psoriasis, and
inflammatory bowel disease. One of the major questions facing the
asthma community is how much improvement in the FEV1 is needed to improve the quality of life of the asthmatic patient. Comparing the various approaches to
asthma treatment, there is typically 15-20% improvement in the lung function with inhaled
steroids.
Leukotriene interventions apparently will improve lung function to similar levels as with inhaled
steroids, and thus may offer an alternative to
steroids. Like the
steroids,
zileuton appears to also reduce the inflammatory cell influx into the
antigen-challenged site, which may have the long-term effect of reversing some of the tissue alterations that occur as a result of the
inflammation seen with
asthma. Importantly, the reported experience to date has shown that the
leukotriene modulators do not have the same side-effects as the current
therapies, and thus offer the hope that both safe and effective treatment may be derived from this approach. The clinical data reported do not yet define a preferred approach to the modulation of
leukotriene pathology. As more studies are published in other diseases the broad spectrum use of these inhibitors will become known.