Montelukast Reduces Serum Levels of Eosinophil-Derived Neurotoxin in Preschool Asthma

• Published in: Allergy, asthma & immunology research Vol. 10; no. 6; pp. 686 - 697
• Main Authors: Kim, Chang-Keun, Callaway, Zak, Park, Jin-Sung, Nishimori, Hisashi, Ogino, Tikatoshi, Nagao, Mizuho, Fujisawa, Takao
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Academy of Asthma, Allergy and Clinical Immunology 01.11.2018; The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease; 대한천식알레르기학회
• Subjects: Asthma; Biomarkers; Budesonide; Children; Clinical trials; Eosinophil-derived neurotoxin; House dust; Immunoglobulin E; Inhalation; Leukocytes (eosinophilic); Medical research; Montelukast; Neurotoxins; Original; Patients; Preschool children; Respiration; Serum levels; 내과학; eosinophil-derived neurotoxin; Biomarkers; asthma; children
• ISSN: 2092-7355; 2092-7363
• DOI: 10.4168/aair.2018.10.6.686

Several markers for eosinophilic inflammation have been proposed to predict response to asthma treatment. However, definitive criteria for treatment decisions have not yet been established. We investigate a potentially useful relatively non-invasive biomarker, eosinophil-derived neurotoxin (EDN), to predict favorable responses to budesonide or montelukast, common treatment for children with asthma. Young children (1 to 6 years old) were enrolled in this randomized, parallel, 2-group, open-label trial. Criteria for eligibility included: 1) being symptomatic during the run-in period; and 2) having a serum EDN (sEDN) level ≥ 53 ng/mL, with positive specific immunoglobulin E to house dust mite. Eligible patients were randomly placed into 2 groups: the BIS group received budesonide inhalation suspension (BIS) 0.5 mg once daily; the MONT group received montelukast 4 mg once daily. Ineligible patients were invited to receive montelukast 4 mg once daily (OBS group). Treatment period was 12 weeks. Asthma control days increased significantly in the BIS and MONT groups ( < 0.000) over the 12-week study period. There was no significant change in sEDN in the BIS group but there was a significant decrease in the MONT group ( < 0.000). Patients in the OBS group with high EDN levels (< 53 ng/mL) showed a significant decrease due to MONT treatment ( = 0.023). Rescue medication usage significantly decreased in the BIS and MONT groups ( < 0.000). EDN is a useful relatively non-invasive biomarker for predicting responses to montelukast and budesonide treatment of preschool children with beta2-agonist responsive recurrent wheeze and multiple-trigger wheeze (Trial registry at UMIN Clinical Trials Registry, UMIN000008335).