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Clin Sci (Lond). 2013 Apr;124(8):521-8. doi: 10.1042/CS20120528.

Tailored second-line therapy in asthmatic children with the Arg(16) genotype.

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1
Asthma and Allergy Research Group, Division of Medicine and Therapeutics, University of Dundee, Dundee DD2 4BF, Scotland, UK. b.j.lipworth@dundee.ac.uk

Abstract

The Arg(16) β(2) receptor genotype confers increased susceptibility to exacerbations in asthmatic children taking regular LABA (long-acting β(2) agonists). We therefore evaluated using montelukast as an alternative to salmeterol as tailored second-line asthma controller therapy in children expressing this susceptible genotype. A total of 62 persistent asthmatic children with the homozygous Arg16 genotype were randomized to receive salmeterol (50 μg, b.i.d.) or montelukast (5 or 10 mg, once daily) as an add-on to inhaled fluticasone for 1 year. School absences (the primary outcome) were reduced with montelukast compared with salmeterol {difference in score=-0.40 [95% CI (confidence interval), -0.22 to -0.58]; P=0.005}. Salbutamol use was also reduced with montelukast compared with salmeterol [difference in score=-0.47 (95% CI, -0.16 to -0.79); P<0.0001]. Greater improvements occurred in both symptom and quality of life scores with montelukast against salmeterol, whereas there was no difference in FEV(1) (forced expiratory volume in 1 s). In conclusion, montelukast may be suitable as tailored second-line controller therapy instead of salmeterol in asthmatic children expressing the susceptible Arg(16) genotype, a move towards a personalized medicine approach to management.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00655616.

PMID:
23126384
DOI:
10.1042/CS20120528
[Indexed for MEDLINE]
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