Leukotriene modifiers in the treatment of asthma

Abstract

Leukotriene modifiers are a new therapeutic class representing a generation of research about the underlying mechanism of asthma. They demonstrate that, once researchers understand the pathways of the disease pathogenesis, they can then proceed to develop medications to interfere with these processes. Zafirlukast and zileuton are the first of these new medications; others are certain to follow. Their development suggests that the future holds further advances for the treatment of asthma. Although intriguing, these new medications do not appear to be as effective as inhaled corticosteroids or more effective than cromolyn or nedocromil. A recent review states that these drugs may be effective in aspirin-sensitive asthma, but their place in the therapy of mild to moderate asthma remains to be determined. The safety and efficacy of inhaled steroids suggest maintaining their continued position as first-line medications for chronic airway anti- inflammation. Until further safety and efficacy data become available, leukotriene-modifier use may have a limited role in long-term control medication for patients older than 12 years, who are intolerant of inhaled corticosteroids. In addition, potential drug-drug interactions, hepatic toxicity, and Churg-Strauss syndrome and associated patient monitoring must be factored into the prescribing decision. The evaluation of leukotriene- modifying drugs in the treatment of asthma is currently hampered by a relative paucity of published clinical experience with these drugs. As more experience is gained with the agents now available and as more leukotriene- modifying drugs with different profiles of efficacy and safety become available, a clearer picture of their utility will no doubt begin to emerge. Hence, another review of this rapidly developing therapeutic area in the next two or three years might yield different conclusions than those that have been reached here.