Montelukast Does not Maintain Symptom Remission After Topical Steroid Therapy for Eosinophilic Esophagitis

Jeffrey A. Alexander, Karthik Ravi, Felicity T Enders, Debra M. Geno, Lori A. Kryzer, Kristin C. Mara, Thomas Christopher Smyrk, David A Katzka

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background & Aims Montelukast, a cysteinyl leukotriene type-1 receptor blocker, has been shown in small retrospective studies to reduce symptoms in patients with eosinophilic esophagitis (EoE). We performed a randomized, placebo-controlled, double-blind trial to determine whether montelukast maintains symptomatic remission induced by topical steroid therapy in patients with EoE. Methods We performed a prospective study of adult patients with EoE (solid-food dysphagia and a peak esophageal eosinophil count of >20 cells/high-powered field) enrolled at the Mayo Clinic in Rochester, Minnesota, from April 2008 through February 2015. All patients had been treated previously for at least 6 weeks with a topical steroid until their symptoms were in remission. Steroids were discontinued and patients then were assigned randomly to groups given montelukast (20 mg/day, n = 20) or placebo (n = 21) for 26 weeks (groups were matched for age, sex, history of allergic disease, reflux symptoms, and endoscopic findings of EoE). Study participants were assessed via a structured telephone interview at weeks 2, 4, 8, 12, 16, 20, and 24. Remission was defined as the absence of solid-food dysphagia. Results Based on an intention-to-treat analysis, after 26 weeks, 40.0% of subjects in the montelukast group and 23.8% in the placebo group were in remission. The odds ratio for remission in the montelukast group was 0.48 (95% confidence interval, 0.10–2.16) (P = .33). No side effects were reported from either group. Conclusions In a randomized controlled trial of the ability of montelukast to maintain remission in patients in remission from EoE after steroid therapy, we found montelukast to be well tolerated; 40% of patients remained in remission, but this proportion did not differ significantly from that of the placebo group. ClinicalTrials.gov no: NCT00511316.

Original languageEnglish (US)
Pages (from-to)214-221.e2
JournalClinical Gastroenterology and Hepatology
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2017

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montelukast
Eosinophilic Esophagitis
Steroids
Placebos
Deglutition Disorders
Therapeutics
Food
Intention to Treat Analysis
Eosinophils

Keywords

  • Clinical Trial
  • Drug
  • Inflammation
  • Swallow
  • Treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Montelukast Does not Maintain Symptom Remission After Topical Steroid Therapy for Eosinophilic Esophagitis. / Alexander, Jeffrey A.; Ravi, Karthik; Enders, Felicity T; Geno, Debra M.; Kryzer, Lori A.; Mara, Kristin C.; Smyrk, Thomas Christopher; Katzka, David A.

In: Clinical Gastroenterology and Hepatology, Vol. 15, No. 2, 01.02.2017, p. 214-221.e2.

Research output: Contribution to journalArticle

Alexander, Jeffrey A. ; Ravi, Karthik ; Enders, Felicity T ; Geno, Debra M. ; Kryzer, Lori A. ; Mara, Kristin C. ; Smyrk, Thomas Christopher ; Katzka, David A. / Montelukast Does not Maintain Symptom Remission After Topical Steroid Therapy for Eosinophilic Esophagitis. In: Clinical Gastroenterology and Hepatology. 2017 ; Vol. 15, No. 2. pp. 214-221.e2.
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abstract = "Background & Aims Montelukast, a cysteinyl leukotriene type-1 receptor blocker, has been shown in small retrospective studies to reduce symptoms in patients with eosinophilic esophagitis (EoE). We performed a randomized, placebo-controlled, double-blind trial to determine whether montelukast maintains symptomatic remission induced by topical steroid therapy in patients with EoE. Methods We performed a prospective study of adult patients with EoE (solid-food dysphagia and a peak esophageal eosinophil count of >20 cells/high-powered field) enrolled at the Mayo Clinic in Rochester, Minnesota, from April 2008 through February 2015. All patients had been treated previously for at least 6 weeks with a topical steroid until their symptoms were in remission. Steroids were discontinued and patients then were assigned randomly to groups given montelukast (20 mg/day, n = 20) or placebo (n = 21) for 26 weeks (groups were matched for age, sex, history of allergic disease, reflux symptoms, and endoscopic findings of EoE). Study participants were assessed via a structured telephone interview at weeks 2, 4, 8, 12, 16, 20, and 24. Remission was defined as the absence of solid-food dysphagia. Results Based on an intention-to-treat analysis, after 26 weeks, 40.0{\%} of subjects in the montelukast group and 23.8{\%} in the placebo group were in remission. The odds ratio for remission in the montelukast group was 0.48 (95{\%} confidence interval, 0.10–2.16) (P = .33). No side effects were reported from either group. Conclusions In a randomized controlled trial of the ability of montelukast to maintain remission in patients in remission from EoE after steroid therapy, we found montelukast to be well tolerated; 40{\%} of patients remained in remission, but this proportion did not differ significantly from that of the placebo group. ClinicalTrials.gov no: NCT00511316.",
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