The purpose of
asthma management is to achieve a total
asthma control that involves current control and future risk. It has proven efficacy in reducing
asthma exacerbations, but the effect size of
zafirlukast for
asthma exacerbations of various severity is not systematically explored.
METHODS: Randomized controlled trials were searched in PubMed Central, Web of Science, and Embase, where
zafirlukast prevented
asthma exacerbations in adults. The primary outcome was
asthma exacerbations, the secondary outcomes were
asthma exacerbations requiring systemic
corticosteroids and emergency visits, respectively. Odds ratio (OR) with 95% confidence intervals (CI) were pooled.
RESULTS: Twelve trials were identified. As first-line
therapy, compared to those having placebo, the patients with chronic
asthma receiving
zafirlukast experienced statistically lower
asthma exacerbations (OR = 0.68, 95% CI = [0.45, 1.00]), but it was not found that
zafirlukast was superior to placebo in
asthma exacerbations requiring systemic
corticosteroids (OR = 0.76, 95% CI = [0.45, 1.29]). Furthermore,
zafirlukast was inferior to ICs in
asthma exacerbations (OR = 2.11, 95% CI = [1.35, 3.30]) and requiring systemic
corticosteroids (OR = 3.71, 95% CI = [1.82, 7.59]). As add-on
therapy,
zafirlukast was not superior to placebo in
asthma exacerbations (OR =0.99, 95% CI = [0.54, 1.81] and requiring emergency visits (OR = 0.72, 95% CI = [0.18, 2.99]). Intriguingly, there was not a significant difference in
asthma exacerbations between
zafirlukast and ICs (OR = 1.12, 95% CI = [0.53, 2.34]).
CONCLUSIONS: Our study suggests that
zafirlukast, as the first-line
therapy, significantly reduces mild to moderate but not severe
asthma exacerbations. In the add-on regimen,
zafirlukast could not reduce
asthma exacerbations, which would perhaps result from small sample size and needs to be further studied.