1
|
Yan J, Sun H, Xin X, Huang T. Association and mechanism of montelukast on depression: A combination of clinical and network pharmacology study. J Affect Disord 2024; 360:214-220. [PMID: 38824963 DOI: 10.1016/j.jad.2024.05.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/19/2024] [Accepted: 05/25/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Post-marketing surveillance found montelukast use was associated with an increased risk of depression. However, results of observational studies are inconsistent. OBJECTIVE This study aimed to assess whether montelukast exposure is associated with depression and elucidate the possible molecular mechanism. METHOD We conducted a cross-sectional study of 9508 adults from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Multivariable regression was used to evaluate the association between montelukast exposure and depression. Network pharmacology was conducted to identify the mechanisms of montelukast on depression. RESULTS Montelukast exposure had a higher prevalence of depression (37.4 %). In a multivariable logistic regression model adjusted for sociodemographic, behavioural, and health characteristics, montelukast exposure was associated with depression (odds ratio [OR]: 1.61; confidence interval [CI]: 1.18-2.19). Network pharmacology was identified 69 key targets of montelukast on depression. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis suggested montelukast mainly works through multiple pathways in endocrine resistance, chemical carcinogenesis-receptor activation, estrogen signaling pathway, etc. LIMITATIONS: Cross-sectional data. CONCLUSIONS The study implies a potential positive association between long-term montelukast exposure and depression through multi-faceted mechanisms. It is suggested that attention be given to the possibility of depression in patients undergoing prolonged montelukast therapy.
Collapse
Affiliation(s)
- Jingchao Yan
- Department of pharmacy, Eye & ENT Hospital, Fudan University, No. 699, Purui Road, Shanghai 201112, People's Republic of China.
| | - Hong Sun
- Department of pharmacy, Eye & ENT Hospital, Fudan University, No. 699, Purui Road, Shanghai 201112, People's Republic of China
| | - Xiu Xin
- Department of pharmacy, Eye & ENT Hospital, Fudan University, No. 699, Purui Road, Shanghai 201112, People's Republic of China
| | - Taomin Huang
- Department of pharmacy, Eye & ENT Hospital, Fudan University, No. 83, Fenyang Road, Shanghai 200031, People's Republic of China.
| |
Collapse
|
2
|
Yan J, Sun H, Xin X, Huang T, Shen J. Leukotriene-modifying agents may increase the risk of depression: A cross-sectional study. J Affect Disord 2024; 356:728-736. [PMID: 38663558 DOI: 10.1016/j.jad.2024.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Post-market monitoring has shown a potential link between the use of leukotriene-modifying agents (LTRAs) and an increased risk of neuropsychiatric events, such as depression. However, observational studies have produced inconsistent findings, offering no definitive conclusions. OBJECTIVE To assess the potential correlation between LTRAs exposure and depression in US adults. METHOD This cross-sectional study, based on population data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016 cycle. The Patient Health Questionnaire-9 was used to assess depression. Multivariable regression was used to evaluate the association between LTRAs exposure and depression. Sensitivity and subgroup analyses were conducted, with the calculation of the E-value. Network pharmacology was employed to investigate the influence of LTRAs on mechanisms of depression. RESULTS Among the 9414 participants, 595 (6.3 %) were classified as having depression. LTRAs exposure was associated with a higher prevalence of depression (16.9 % vs. 6.0 %). The multivariable logistic regression results showed that LTRAs use increased the risk of depression (OR = 1.70; 95 % CI, 1.05-2.75). An association between LTRAs exposure and depression was found in sensitivity analyses conducted regardless of multivariable linear regression with the PHQ-9 score as a continuous variable (β = 0.97; 95 % CI, 0.44-1.50) or multivariable logistic regression with the PHQ-9 cut-off of 5 (OR = 1.52; 95 % CI, 1.08-2.14). The association between LTRAs and depression was stable in the different subgroups. CONCLUSION LTRAs exposure is positively associated with depression in US adults. Therefore, the risk for depression in patients receiving long-term LTRAs treatment should be considered.
Collapse
Affiliation(s)
- Jingchao Yan
- Department of pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 2600, Jiangyue Road, Shanghai 200031, China.
| | - Hong Sun
- Department of pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 2600, Jiangyue Road, Shanghai 200031, China
| | - Xiu Xin
- Department of pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 2600, Jiangyue Road, Shanghai 200031, China
| | - Taomin Huang
- Department of pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 83, Fenyang Road, Shanghai 200031, China
| | - Jianwen Shen
- Department of pharmacy, Eye Ear Nose Throat Hospital of Fudan University, No. 83, Fenyang Road, Shanghai 200031, China.
| |
Collapse
|
3
|
Li Y, Zhang M, Zhang S, Yang G. Promising Effects of Montelukast for Critically Ill Asthma Patients via a Reduction in Delirium. Pharmaceuticals (Basel) 2024; 17:125. [PMID: 38256958 PMCID: PMC10819207 DOI: 10.3390/ph17010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Montelukast (MTK), a potent antagonist of cysteinyl leukotriene receptor 1, has shown therapeutic promise for the treatment of neuropsychiatric disorders. Delirium, a common complication in critically ill patients, lacks effective treatment. This study aims to explore the impact of pre-intensive care unit (ICU) MTK use on in-hospital delirium incidence and, subsequent, prognosis in critically ill patients. Methods: A retrospective cohort study (n = 6344) was conducted using the MIMIC-IV database. After propensity score matching, logistic/Cox regression, E-value sensitivity analysis, and causal mediation analysis were performed to assess associations between pre-ICU MTK exposure and delirium and prognosis in critically ill patients. Results: Pre-ICU MTK use was significantly associated with reduced in-hospital delirium (OR: 0.705; 95% CI 0.497-0.999; p = 0.049) and 90-day mortality (OR: 0.554; 95% CI 0.366-0.840; p = 0.005). The association was more significant in patients without myocardial infarction (OR: 0.856; 95% CI 0.383-0.896; p = 0.014) and could be increased by extending the duration of use. Causal mediation analysis showed that the reduction in delirium partially mediated the association between MTK and 90-day mortality (ACME: -0.053; 95% CI -0.0142 to 0.0002; p = 0.020). Conclusions: In critically ill patients, MTK has shown promising therapeutic benefits by reducing the incidence of delirium and 90-day mortality. This study highlights the potential of MTK, beyond its traditional use in respiratory disease, and may contribute to the development of novel therapeutic strategies for delirium.
Collapse
Affiliation(s)
- Yuan Li
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China; (Y.L.); (M.Z.)
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| | - Meilin Zhang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China; (Y.L.); (M.Z.)
| | - Shengnan Zhang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China; (Y.L.); (M.Z.)
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, China; (Y.L.); (M.Z.)
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410013, China
| |
Collapse
|
4
|
Lo CWH, Pathadka S, Qin SX, Fung LWY, Yan VKC, Yiu HHE, Bloom CI, Wong ICK, Chan EWY. Neuropsychiatric events associated with montelukast in patients with asthma: a systematic review. Eur Respir Rev 2023; 32:230079. [PMID: 37758273 PMCID: PMC10523155 DOI: 10.1183/16000617.0079-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The United States Food and Drug Administration issued a black box warning on the mental health adverse effects of montelukast in 2020. Age-related effects on the risk of developing specific neuropsychiatric events in montelukast users remain largely unknown. OBJECTIVE To describe the risk of neuropsychiatric events associated with montelukast in adults and children with asthma. METHODS A systematic search of all studies investigating neuropsychiatric events in montelukast users was performed in PubMed, the Cochrane Library and Embase from inception to 7 September 2022. Animal studies and conference abstracts were excluded. RESULTS 59 studies (21 pharmacovigilance studies, four reviews from 172 randomised controlled trials, 20 observational studies, 10 case reports and four case series) evaluating neuropsychiatric events in patients with asthma on montelukast were reviewed. No significant association was shown between montelukast and suicide-related events in six of the observational studies. No association was found for depression as defined by the International Classification of Diseases 10th revision codes in three observational studies and a review of randomised clinical trials. However, findings from four studies using antidepressant prescriptions as the outcome identified significant associations. Consistent with nine pharmacovigilance studies, two large-scale observational studies revealed possible associations of montelukast with anxiety and sleeping disorders in adult patients with asthma, respectively. However, the results were not replicated in two observational studies on children. CONCLUSION Montelukast is not associated with suicide- and depression-related events in asthma patients. Older adults may be particularly susceptible to anxiety and sleeping disorders.
Collapse
Affiliation(s)
- Chris Wai Hang Lo
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Swathi Pathadka
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- LCCI - Value, Evidence, Outcomes Division, Eli Lilly Services India Private Limited, Bengaluru, India
| | - Simon Xiwen Qin
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Lydia W Y Fung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hei Hang Edmund Yiu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
| |
Collapse
|
5
|
Bai L, Xu Y, Pan T, Zhang Y, Zhou X, Xu J. Leukotriene Receptor Antagonists and Risk of Neuropsychiatric Entities: A Meta-Analysis of Observational Studies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:844-854.e9. [PMID: 36473625 DOI: 10.1016/j.jaip.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Leukotriene receptor antagonists (LTRAs) are commonly prescribed to patients with allergic diseases. Several case reports and pharmacovigilance studies have indicated that LTRAs might increase the risk of neuropsychiatric (NP) entities. However, the results are mixed in observational studies. Thus, the association between LTRAs and NP entities remains controversial. OBJECTIVE To quantitatively evaluate the NP risk with LTRAs based on current observational studies to provide a reference for clinical practice. METHODS We systematically reviewed the literature in Medline, Embase, Web of Science, Cochrane Library, Scopus, and PsycINFO. A meta-analysis of observational studies that investigated the association between LTRA use and the risk of NP entities was performed. Odds ratios (OR) with 95% confidence intervals (CI) were used to measure the effect; heterogeneity was evaluated using I-squared (I2) statistics. Subgroup and sensitivity analyses were conducted to assess bias. RESULTS Eleven articles were included in the primary analysis. No significant association was found between LTRA use and NP entities (OR: 1.08, 95% CI: 0.93-1.24, I2 = 93.7%). In patients with allergic rhinitis (AR), a mildly increased NP risk was found (OR: 1.099, 95% CI: 1.004-1.202). The association between LTRA use and NP entities was not significant in patients with asthma (OR: 1.06, 95% CI: 0.90-1.26). LTRAs increased the risk of NP entities in a single study using data from an asthma clinic (OR: 9.00, 95% CI: 1.20-69.50), but not in studies from databases (OR: 1.07, 95% CI: 0.93-1.23). CONCLUSION At the population level, LTRAs and NP entities were unrelated. However, the association may exist in particular groups (eg, patients with AR or NP history). Subject-specific studies are required to further examine the relationship between LTRAs and NP entities and identify the underlying mechanisms.
Collapse
Affiliation(s)
- Le Bai
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yong Xu
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tingyu Pan
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Zhang
- Department of Stomatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xianmei Zhou
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
| | - Jie Xu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China; Department of Respiratory Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| |
Collapse
|
6
|
Al-Shamrani A, Alharbi S, Kobeisy S, AlKhater SA, Alalkami H, Alahmadi T, Almutairi A, Alharbi AS, Yousef AA. Adverse Drug Reactions (ADRs) of Montelukast in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1783. [PMID: 36421233 PMCID: PMC9688958 DOI: 10.3390/children9111783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2023]
Abstract
UNLABELLED Montelukast is a leukotriene receptor antagonist (LTRA) commonly prescribed for asthma, allergic rhinitis and sleep-related breathing disorders. Recently, some studies have reported several adverse events, such as neuropsychiatric disorders and sleep disturbances, among children. OBJECTIVE To obtain more insight into the safety profile of montelukast for children with asthma, allergic rhinitis and sleep-related breathing disorders. METHOD AND RESULTS We retrospectively studied all adverse drug reactions to montelukast among 385 children 6 months or older in six tertiary centers over a two-year period. A total of 89.6% were asthmatic, 50% had allergic rhinitis and 13.6% had sleep-related breathing disorders; Singulair was the most common type of montelukast used (67.9%). This study reported a high prevalence of adverse drug reactions among 123 patients (31.9%), predominantly in those aged 4-9 years (52.8%), followed by adolescents (24.4%) and toddlers (22.8%). Two (ADRs) were reported in 9.8% of the children, while three or more were reported in 5.5%. Sleep disturbance was the most common (ADRs), affecting 15.1% of participants (overlap was common; 5.5% of children experienced sleep difficulties, 4.4% experienced sleep interruption and decreased sleep, and 1.82% experienced nightmares), followed by agitation (10.4%), pain (9.4%) and hyperactivity (6.8%). No serious (ADRs) were reported. Eleven percent of families faced difficulties in purchasing montelukast, and only 57% of families had insurance. Misconceptions were common (9.8% reported it to be a steroid, while 30.6% believed it to be a bronchodilator). Although 81% of the families believed it was an effective and preventive medication, 5.3% stopped the drug due to concern about side effects, especially agitation (3%) and nightmares (0.6%). CONCLUSION These data demonstrate that montelukast is effective, but the associated adverse neuropsychiatric drug reactions are more prevalent than those reported in the literature. In particular, sleep disturbance, agitation, pain and hyperactivity were observed. Pediatricians should be aware of such (ADRs). Misconceptions about montelukast are still common, and parental counseling and urgent epidemiological studies are needed to quantify the risk for management plans.
Collapse
Affiliation(s)
- Abdullah Al-Shamrani
- Department of Pediatrics, Prince Sultan Military Medical City, AL Faisal University, P.O. Box 7897, Riyadh 11159, Saudi Arabia
| | - Saleh Alharbi
- Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
- Department of Paediatrics, Umm Al-Qura University, Mecca 24382, Saudi Arabia
| | - Sumayyah Kobeisy
- Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
| | - Suzan A. AlKhater
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Pediatrics, King Fahd Hospital of the University, Al-Khobar 31952, Saudi Arabia
| | - Haleimah Alalkami
- Department of Pediatrics, Abha Maternity & Children Hospital, P.O. Box 62521, Abha 1650, Saudi Arabia
| | - Turki Alahmadi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Aisha Almutairi
- Department of Pediatrics, College of Medicine, Qassim University, P.O. Box 7897, Buraidah 51452, Saudi Arabia
| | - Adel S. Alharbi
- Department of Pediatrics, Prince Sultan Military Medical City, AL Faisal University, P.O. Box 7897, Riyadh 11159, Saudi Arabia
| | - Abdullah A. Yousef
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
- Department of Pediatrics, King Fahd Hospital of the University, Al-Khobar 31952, Saudi Arabia
| |
Collapse
|
7
|
Tsai ML, Lin HC, Yen CH, Ku JT, Sung SY, Chang H. Increased Risk of Tourette Syndrome with Leukotriene Modifier Use in Children with Allergic Diseases and Asthma: A Nationwide Population-Based Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111607. [PMID: 36360335 PMCID: PMC9688072 DOI: 10.3390/children9111607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023]
Abstract
(1) Background: Cysteinyl leukotriene receptor antagonists (LTRAs), including montelukast and zafirlukast, are FDA-approved for treating pediatric asthma and allergic diseases. Tourette syndrome (TS), a common neuropsychiatric disorder in children, is associated with allergic diseases and asthma. In this study, we investigated the risk of TS following an LTRA prescription for pediatric allergic diseases. (2) Methods: Children younger than 18 years of age who were newly diagnosed with asthma, allergic rhinitis, or atopic dermatitis between 1 January 2005 and 31 December 2018 and who were registered in the Taiwan National Health Insurance Research Database, which comprises the medical records of nearly 23 million Taiwanese population, were enrolled. LTRA users were matched with randomly selected LTRA non-users by sex, age, asthma-diagnosis year, and urbanization level. In total, 26,984 participants with allergic disease and TS were enrolled and included in the Cox proportional hazards model analysis. (3) Results: Children with allergic disease and asthma treated with LTRAs had a higher risk for TS than LTRA non-users (adjusted hazard ratio 1.376 [95% CI: 1.232−1.536], p < 0.001). LTRA users had a significantly higher risk for TS than LTRA non-users with allergic disease. The cumulative incidence of TS was significantly higher in LTRA users than in non-users with allergic diseases and asthma (log-rank test, p < 0.0001). (4) Conclusion: A prescription of LTRAs, mainly montelukast, increased the risk of TS among children with asthma, allergic rhinitis, or atopic dermatitis. The mechanism underlying the neuropsychiatric effect of LTRAs needs further investigation.
Collapse
Affiliation(s)
- Min-Lan Tsai
- Department of Pediatrics, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Hsiu-Chen Lin
- Department of Pediatrics, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Clinical Pathology, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chiung-Hui Yen
- Department of Pediatrics, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jung-Tzu Ku
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shian-Ying Sung
- International Ph.D. Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- Office of Human Research, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (S.-Y.S.); (H.C.); Tel.: +886-2-6638-2736 (ext. 1701) (S.-Y.S.); +886-2-2737-2181 (ext. 3715) (H.C.)
| | - Hsi Chang
- Department of Pediatrics, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (S.-Y.S.); (H.C.); Tel.: +886-2-6638-2736 (ext. 1701) (S.-Y.S.); +886-2-2737-2181 (ext. 3715) (H.C.)
| |
Collapse
|
8
|
Rostevanov IS, Betesh-Abay B, Nassar A, Rubin E, Uzzan S, Kaplanski J, Biton L, Azab AN. Montelukast induces beneficial behavioral outcomes and reduces inflammation in male and female rats. Front Immunol 2022; 13:981440. [PMID: 36148246 PMCID: PMC9487911 DOI: 10.3389/fimmu.2022.981440] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Accumulative data links inflammation and immune dysregulation to the pathophysiology of mental disorders; little is known regarding leukotrienes’ (LTs) involvement in this process. Circumstantial evidence suggests that treatment with leukotriene modifying agents (LTMAs) such as montelukast (MTK) may induce adverse neuropsychiatric events. Further methodic evaluation is warranted. Objective This study aims to examine behavioral effects, as well as inflammatory mediator levels of chronic MTK treatment in male and female rats. Methods Depression-like phenotypes were induced by exposing male and female rats to a chronic unpredictable mild stress (CUMS) protocol for four weeks. Thereafter, rats were treated (intraperitoneally) once daily, for two weeks, with either vehicle (dimethyl sulfoxide 0.2 ml/rat) or 20 mg/kg MTK. Following treatment protocols, behavioral tests were conducted and brain regions were evaluated for inflammatory mediators including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and prostaglandin (PG) E2. Results Overall, MTK did not invoke negative behavioral phenotypes (except for an aggression-inducing effect in males). Numerous positive behavioral outcomes were observed, including reduction in aggressive behavior in females and reduced manic/hyperactive-like behavior and increased sucrose consumption (suggestive of antidepressant-like effect) in males. Furthermore, in control males, MTK increased IL-6 levels in the hypothalamus and TNF-α in the frontal cortex, while in control females it generated a robust anti-inflammatory effect. In females that were subjected to CUMS, MTK caused a prominent reduction in TNF-α and IL-6 in brain regions, whereas in CUMS-subjected males its effects were inconsistent. Conclusion Contrary to prior postulations, MTK may be associated with select beneficial behavioral outcomes. Additionally, MTK differentially affects male vs. female rats in respect to brain inflammatory mediators, plausibly explaining the dissimilar behavioral phenotypes of sexes under MTK treatment.
Collapse
Affiliation(s)
- Ira S. Rostevanov
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Batya Betesh-Abay
- Department of Nursing, School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ahmad Nassar
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elina Rubin
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sarit Uzzan
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacob Kaplanski
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Linoy Biton
- Department of Nursing, School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Abed N. Azab
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Nursing, School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- *Correspondence: Abed N. Azab,
| |
Collapse
|
9
|
Paljarvi T, Forton J, Luciano S, Herttua K, Fazel S. Analysis of Neuropsychiatric Diagnoses After Montelukast Initiation. JAMA Netw Open 2022; 5:e2213643. [PMID: 35608857 PMCID: PMC9131741 DOI: 10.1001/jamanetworkopen.2022.13643] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE The evidence base for the association between montelukast and adverse neuropsychiatric outcomes is mixed and inconclusive. Several methodological limitations have been identified in the evidence base on the safety of montelukast in observational studies. OBJECTIVE To investigate the association between new montelukast exposure and 1-year incident neuropsychiatric diagnoses with improved precision and control for baseline confounders. DESIGN, SETTING, AND PARTICIPANTS This propensity score-matched cohort study was conducted using electronic health records from 2015 to 2019 in the TriNetX Analytics Network patient repository of more than 51 million patients from 56 health care organizations, mainly in the US. Included patients were those aged 15 to 64 years at index prescription for montelukast or for control prescription who had a history of asthma or allergic rhinitis. After propensity score matching for various baseline confounders, including comorbidities and dispensed prescription medicines, we included 154 946 patients, of whom 77 473 individuals were exposed to montelukast. Patients were followed up for 12 months. Data were analyzed from June through November 2021. EXPOSURES New dispensed prescription for leukotriene receptor antagonist montelukast or control medication. MAIN OUTCOMES AND MEASURES Incident neuropsychiatric diagnoses at 12 months identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. RESULTS There were 72 490 patients with asthma (44 726 [61.7%] women; mean [SD] age at index prescription, 35 [15] years) and 82 456 patients with allergic rhinitis (54 172 [65.7%] women; mean [SD] age at index prescription, 40 [14] years). In patients exposed to montelukast, the odds ratio [OR] for any incident neuropsychiatric outcome was 1.11 (95% CI, 1.04-1.19) in patients with asthma and 1.07 (95% CI, 1.01-1.14) in patients with allergic rhinitis compared with patients who were unexposed. The highest OR was for anxiety disorders (OR, 1.21; 95% CI, 1.05-1.20) among patients with asthma exposed to montelukast and insomnia (OR, 1.15; 95% CI, 1.05-1.27) among patients with allergic rhinitis exposed to montelukast. CONCLUSIONS AND RELEVANCE This study found that patients with asthma or allergic rhinitis had increased odds of adverse neuropsychiatric outcomes after montelukast initiation. These findings suggest that clinicians should consider monitoring potential adverse mental health symptoms during montelukast treatment, particularly in individuals with a history of mental health or sleep problems.
Collapse
Affiliation(s)
- Tapio Paljarvi
- Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, England, United Kingdom
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Julian Forton
- Children’s Hospital for Wales, Heath Park, Cardiff, Wales, United Kingdom
| | | | - Kimmo Herttua
- Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, England, United Kingdom
- Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, England, United Kingdom
| |
Collapse
|
10
|
May BC, Gallivan KH. Levocetirizine and montelukast in the COVID-19 treatment paradigm. Int Immunopharmacol 2021; 103:108412. [PMID: 34942461 PMCID: PMC8673734 DOI: 10.1016/j.intimp.2021.108412] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022]
Abstract
Levocetirizine, a third-generation antihistamine, and montelukast, a leukotriene receptor antagonist, exhibit remarkable synergistic anti-inflammatory activity across a spectrum of signaling proteins, cell adhesion molecules, and leukocytes. By targeting cellular protein activity, they are uniquely positioned to treat the symptoms of COVID-19. Clinical data to date with an associated six-month follow-up, suggests the combination therapy may prevent the progression of the disease from mild to moderate to severe, as well as prevent/treat many of the aspects of ‘Long COVID,’ thereby cost effectively reducing both morbidity and mortality. To investigate patient outcomes, 53 consecutive COVID-19 test (+) cases (ages 3–90) from a well-established, single-center practice in Boston, Massachusetts, between March – November 2020, were treated with levocetirizine and montelukast in addition to then existing protocols [2]. The data set was retrospectively reviewed. Thirty-four cases were considered mild (64%), 17 moderate (32%), and 2 (4%) severe. Several patients presented with significant comorbidities (obesity: n = 22, 41%; diabetes: n = 10, 19%; hypertension: n = 24, 45%). Among the cohort there were no exclusions, no intubations, and no deaths. The pilot study in Massachusetts encompassed the first COVID-19 wave which peaked on April 23, 2020 as well as the ascending portion of the second wave in the fall. During this period the average weekly COVID-19 case mortality rate (confirmed deaths/confirmed cases) varied considerably between 1 and 7.5% [37]. FDA has approved a multicenter, randomized, placebo-controlled, Phase 2 clinical trial design, replete with electronic diaries and laboratory metrics to explore scientific questions not addressed herein.
Collapse
Affiliation(s)
- Bruce Chandler May
- Inflammatory Response Research, Inc., 515 E. Micheltorena, Suite G, Santa Barbara, CA 93103, United States; Otolaryngology, Head & Neck Surgery, Cottage Health, 400 West Pueblo Street, Santa Barbara, CA 93105, United States.
| | - Kathleen Holly Gallivan
- Otolaryngology, Head & Neck Surgery, 100 Unicorn Park, Suite 102, Woburn, MA 01801, United States.
| |
Collapse
|
11
|
Shim JS, Kim MH, Kim MH, Cho YJ, Chun EM. Risk of Neuropsychiatric Diseases According to the use of a Leukotriene Receptor Antagonist in Middle-Aged and Older Adults with Asthma: a Nationwide Population-Based Study Using Health Claims Data in Korea. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4290-4297. [PMID: 34166842 DOI: 10.1016/j.jaip.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although a leukotriene receptor antagonist (LTRA) is an effective drug for asthma, there has been increasing concern regarding neuropsychiatric (NP) adverse reactions. However, evidence for this association is not sufficient, especially in adults. OBJECTIVE To investigate the association between the use of an LTRA and the risk of developing NP diseases in adults with asthma. METHODS We performed a nationwide, retrospective, cohort study using data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS). We selected asthma patients with no previous use of an LTRA, and NP outcomes were defined by the registration of certain International Classification of Diseases, 10th Revision codes (F00-F59) during follow-up. We obtained the hazard ratio (HR) for NP diseases according to the use of an LTRA. RESULTS Overall, 61,571 asthma patients without LTRA experience were enrolled, and 12,168 of them took an LTRA during the follow-up period. In the adjusted model, the HR for newly diagnosed NP diseases showed no significant difference according to use of an LTRA (HR 1.01; 95% confidence interval 0.83-1.23; P = .952). Subgroup analysis for associations between duration of LTRA use and risk of NP disease indicated no significance for all groups (<6, 6 to <12, 12 to <24, and ≥24 months). Common NP diseases included dementia (75.4% vs 76.1%), mood disorders (12.68% vs 12.80%), and panic disorders (5.63% vs 3.53%) in LTRA users and non-LTRA users, respectively, and there was no significant difference in the prevalence of each NP disease in either group. CONCLUSIONS The current study showed the use or duration of LTRA exposure was not associated with the occurrence of NP diseases in Korean adult asthmatics.
Collapse
Affiliation(s)
- Ji-Su Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Ho Kim
- Department of Informatization, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Young-Joo Cho
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Eun Mi Chun
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| |
Collapse
|
12
|
Clarridge K, Chin S, Eworuke E, Seymour S. A Boxed Warning for Montelukast: The FDA Perspective. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2638-2641. [PMID: 33744471 DOI: 10.1016/j.jaip.2021.02.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022]
Abstract
The U.S. Food and Drug Administration (FDA) became aware of postmarketing reports of neuropsychiatric adverse events with Singulair (montelukast) use in 2007. Over the years, the FDA has conducted reviews of the clinical trial safety data, focused analyses of postmarketing reports, and reviews of the published literature. These activities have resulted in successive labeling updates and public communications. However, there has been continued concern among stakeholders about the risk of neuropsychiatric events and the lack of awareness among prescribers and patients/caregivers. On the basis of these concerns, the FDA embarked on another comprehensive review and also conducted a new observational study using claims data in the Sentinel Distributed Database. In September 2019, the FDA held a public Advisory Committee meeting to discuss its review and solicit recommendations from the panel regarding labeling and communication strategies. After careful consideration of the available data and feedback received during the FDA Advisory Committee meeting, the FDA required a boxed warning and a revision specifically for the allergic rhinitis indication to reserve use of montelukast to patients who have an inadequate response or intolerance to alternative therapies. Based on benefit-risk considerations, the asthma indication was not changed. To provide insight into the process and rationale for the required labeling changes, we provide an overview of the decision-making framework we used.
Collapse
Affiliation(s)
- Katherine Clarridge
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md.
| | - Stacy Chin
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Efe Eworuke
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Sally Seymour
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| |
Collapse
|
13
|
Kang SO, Min KH, Kim HJ, Kim TH, Kim W, Lee KE. The role of leukotriene modifying agent treatment in neuropsychiatric events of elderly asthma patients: a nested case control study. Asthma Res Pract 2021; 7:4. [PMID: 33731203 PMCID: PMC7972201 DOI: 10.1186/s40733-021-00070-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
Background In March 2020, the US Food and Drug Administration decided that the dangers related to neuropsychiatric events (NPEs) of montelukast, one of the leukotriene modifying agents (LTMAs), should be communicated through ‘boxed warning’. In case of NPEs, the prevalence has been the highest in elderly people. Because the characteristics of the elderly such as old age itself can act as risk factors. Therefore, an investigation on safety of LTMAs related to NPEs in elderly using LTMAs is needed. Method A nested case-control study using an elderly sample cohort from the Korean National Health Insurance Service database was used. The asthma cohort included asthma patients newly diagnosed between 2003 and 2013. Within the asthma cohort, the case group was defined as patients who were diagnosed with NPEs. Among patients who had never been diagnosed with NPEs, the control group was selected by matching 1:1 by propensity score. Patients who were prescribed LTMAs for 1 year prior to index date were defined as the exposure group. The logistic regression model was used to measure the effect of LTMAs on NPEs. Results We identified 141,165 patients with newly diagnosed asthma, and selected 31,992 patients per each case and control group. Exposure to LTMAs significantly increased the risk of overall NPEs about in comparison with the absence of exposure (crude odds ratio [OR] 1.58, 95% CI 1.50–1.68). After adjusting for confounding factors, the overall NPEs risk increased (adjusted OR, 1.67, 95% CI 1.58–1.78). Conclusion This study suggests that elderly asthma patients prescribed LTMAs had a higher risk of NPEs than patients who were not treated with LTMAs. Therefore, clinicians should be aware of the potential risks of LTMAs.
Collapse
Affiliation(s)
- Sang Oh Kang
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Kyung Hyun Min
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Hyun Jeong Kim
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Tae Hyeok Kim
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Woorim Kim
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, 660-1 Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Republic of Korea.
| |
Collapse
|
14
|
Tel BC, Telli G, Onder S, Nemutlu E, Bozkurt TE. Investigation of the relationship between chronic montelukast treatment, asthma and depression-like behavior in mice. Exp Ther Med 2020; 21:27. [PMID: 33262813 PMCID: PMC7690246 DOI: 10.3892/etm.2020.9459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
In 2008, the Food and Drug Administration of the US issued a warning about the neuropsychiatric side effects of montelukast. Previous clinical studies on montelukast have reported conflicting results and, to the best of our knowledge, no experimental studies concerning these side effects had been conducted. In the current study, the effect of montelukast on depression-like behavior in an ovalbumin (OVA)-induced mouse model was investigated. A total of 3 OVA challenges were applied at 2 week intervals for the persistence of asthma. Depression-like behavior was assessed using forced swim tests following each challenge and locomotor activities were evaluated using open field tests. At the end of the current study, plasma montelukast concentrations were measured and the development of asthma and effect of montelukast treatment were histopathologically examined. Inflammation scores that were increased in the OVA mice following all challenges were indicated to be reduced by montelukast treatment. The immobility time of mice increased beginning with the first challenge and this was also reduced by montelukast treatment. Montelukast administration to the control mice did not alter immobility times. Moreover, motor activity of the OVA and montelukast-treated mice were not altered. The results indicated there was no association between chronic montelukast treatment and depression. Furthermore, the chronic administration of montelukast to non-asthmatic mice did not increase immobility. However, depressive behavior increased at all time points in the OVA mice. These results indicated that chronic montelukast treatment is not associated with depression-like behavior and confirmed the association between asthma and depression. Further studies are required to provide an improved understanding of the neuropsychiatric side effects of montelukast.
Collapse
Affiliation(s)
- Banu Cahide Tel
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Gokcen Telli
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Sevgen Onder
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Sihhiye 06100, Turkey
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| | - Turgut Emrah Bozkurt
- Department of Pharmacology, Hacettepe University Faculty of Pharmacy, Ankara, Sihhiye 06100, Turkey
| |
Collapse
|
15
|
Huang PY, Yang YH, Huang YH, Kuo HC, Wang LJ, Chien SJ, Chang LS. Montelukast does not increase the risk of attention-deficit/hyperactivity disorder in pediatric asthma patients: A nationwide population-based matched cohort study. J Formos Med Assoc 2020; 120:1369-1376. [PMID: 33158697 DOI: 10.1016/j.jfma.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) has been linked to pediatric asthma patients treated with montelukast. This study is the first to use a nationwide health insurance research database (NHIRD) to study whether asthmatic children using montelukast are at an increased risk of ADHD. METHODS We used data from the Taiwan NHIRD, which is a longitudinal database of one million randomly selected subjects. The enrolled patients were followed up until 2013. Patients younger than and equal to 12 years old with new-onset asthma (ICD-9 CM code 493.X) diagnosed between 1997 and 2013 were enrolled. A multivariate Cox regression analysis was conducted to evaluate the association between montelukast treatment and the risk of ADHD (ICD-9-CM code 314.X). RESULTS We enrolled a total of 54,487 asthmatic children younger than and equal to 12 years old who had at least one claim of inpatient admission or at least three claims of an ambulatory visit. Montelukast users and match controls were identified by matching age, gender, residence, the comorbidities including allergic rhinitis and atopic dermatitis, admission or emergency department visits due to asthma attack, and index date of starting montelukast in a 1:1 ratio, with 12,806 in the montelukast group and 12,806 in the non-montelukast group. The montelukast group had a similar risk of ADHD (n = 632, 4.94%) as the non-montelukast group (n = 610, 4.76%) [adjusted hazard ratio 1.04; 95% confidence interval, 0.93 to 1.17]. In children treated with montelukast, high cumulative days of montelukast use did not increase the risk of ADHD. CONCLUSION This nationwide population-based cohort study reveals that asthma children treated with montelukast were not at an increased risk of developing ADHD. Nevertheless, validation of our retrospective survey requires further prospective study.
Collapse
Affiliation(s)
- Po-Yu Huang
- Department of Traditional Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hua Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
16
|
Risk of Psychiatric Adverse Events Among Montelukast Users. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:385-393.e12. [PMID: 32795564 DOI: 10.1016/j.jaip.2020.07.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/25/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND There have been conflicting results from observational studies regarding the risk of psychiatric adverse events (PAEs) with montelukast use. OBJECTIVE To determine whether there are associations of depressive disorders, self-harm, and suicide with use of montelukast compared with inhaled corticosteroid (ICS) use. METHODS Using data from the Sentinel Distributed Database from January 1, 2000, to September 30, 2015, patients (n = 457,377) exposed to montelukast or ICS, aged 6 years and older with a diagnosis of asthma, were matched 1:1 on propensity scores. Hazard ratios (HRs) and 95% CIs were estimated for each study outcome overall and by age, sex, psychiatric history, and pre-/post-2008 labeling updates using Cox proportional hazards regression models. RESULTS Exposure to montelukast was associated with a lower risk of treated outpatient depressive disorder (HR, 0.91; 95% CI, 0.89-0.93). No increased risks of inpatient depressive disorder (HR, 1.06; 95% CI, 0.90-1.24), self-harm (HR, 0.92; 95% CI, 0.69-1.21), or self-harm using a modified algorithm (HR, 0.81; 95% CI, 0.63-1.05) were observed with montelukast use compared with ICS use. Most PAEs occurred in the roughly one-third of patients having a past psychiatric history. CONCLUSIONS When compared with use of ICS, we did not find associations between montelukast use and hospitalizations for depression or self-harm events. Our findings should be interpreted considering the study's limitations. Psychiatric comorbidity was common, and most PAEs occurred in patients with a past psychiatric history.
Collapse
|
17
|
Tseng YT, Cox TM, Grant GD, Arora D, Hall S, McFarland AJ, Ekberg J, Rudrawar S, Anoopkumar-Dukie S. In vitro cytotoxicity of montelukast in HAPI and SH-SY5Y cells. Chem Biol Interact 2020; 326:109134. [PMID: 32464120 DOI: 10.1016/j.cbi.2020.109134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022]
Abstract
Montelukast is a cysteinyl leukotriene (CysLT) receptor antagonist with efficacy against a variety of diseases, including asthma and inflammation-related conditions. However, various neuropsychiatric events (NEs) suspected to be related to montelukast have been reported recently, with limited understanding on their association and underlying mechanisms. This study aimed to investigate whether montelukast can induce neuroinflammation and neurotoxicity in microglial HAPI cells and neural SH-SY5Y cells. The present study also compared the effects of montelukast with a 5-lipoxygenase inhibitor (zileuton) and a cyclooxygenase-2 inhibitor (celecoxib) to better understand modulation of related pathways. HAPI or SH-SY5Y cells were treated with the indicated drugs (3.125 μM-100 μM) for 24 h to investigate drug-induced neuroinflammation and neurotoxicity. Montelukast induced cytotoxicity in HAPI cells (50-100 μM), accompanied with caspase-3/7 activation, prostaglandin E2 (PGE2) release, and reactive oxygen species (ROS) production. Whilst both montelukast and zileuton down-regulated CysLT release in HAPI cells, zileuton did not significantly affect cell viability or inflammatory and oxidative factors. Celecoxib decreased HAPI cell viability (6.25-100 μM), accompanied with increasing caspase-3/7 activation and ROS production, but in contrast to montelukast increased CysLT release and decreased PGE2 production. Similar to observations in HAPI cells, both montelukast and celecoxib (50-100 μM) but not zileuton produced toxicity in SH-SY5Y neuroblastoma cells. Similarly, CM from HAPI cells treated with either montelukast or zileuton produced toxicity in SH-SY5Y cells. The results of the current study show the capability of montelukast to directly induce toxicity and inflammation in HAPI cells, possibly through the involvement of PGE2 and ROS, and toxicity in undifferentiated SH-SY5Y neuroblastoma cells. The current study highlights the importance of consideration between benefit and risk of montelukast usage and provides references for future investigation on decreasing montelukast-related NEs.
Collapse
Affiliation(s)
- Yu-Ting Tseng
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Tynan M Cox
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Gary D Grant
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Devinder Arora
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Susan Hall
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Amelia J McFarland
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Jenny Ekberg
- Menzies Health Institute Queensland, Griffith University, Queensland, 4222, Australia; Griffith Institute for Drug Discovery, Griffith University, Queensland, 4111, Australia
| | - Santosh Rudrawar
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia
| | - Shailendra Anoopkumar-Dukie
- School of Pharmacy and Pharmacology, Griffith University, Queensland, 4222, Australia; Quality Use of Medicines Network, Queensland, Australia.
| |
Collapse
|
18
|
Kim S, Cheon SM, Suh HS. Association Between Drug Exposure and Occurrence of Parkinsonism in Korea: A Population-Based Case-Control Study. Ann Pharmacother 2019; 53:1102-1110. [PMID: 31216861 DOI: 10.1177/1060028019859543] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Although drug-induced parkinsonism is reversible in most cases, some patients can suffer from persistent/recurrent symptoms. Therefore, prevention is the most efficient way to manage drug-induced parkinsonism. However, there is a paucity of studies exploring the relationship between parkinsonism and drug exposure. Objective: To examine the association between drug exposure and the risk of parkinsonism using Korean population-based data. Methods: We conducted a matched case-control study using the National Health Insurance Service-National Sample Cohort database. Cases and controls were defined as individuals with and without parkinsonism, respectively, between 2007 and 2013. Cases and controls were matched for sex, age group, income, type of insurance, and Charlson comorbidity index. Drug exposures, including propulsives, antipsychotics, and flunarizine, were identified at 1 year before the first date of parkinsonism and stratified by recency and cumulative dose. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Results: We identified 5496 cases and 5496 controls. ORs for current use group of propulsives, antipsychotics, and flunarizine compared with those of the never use group were 2.812 (95% CI = 2.466-3.206), 3.009 (95% CI = 1.667-5.431), and 4.950 (95% CI = 2.711-9.037), respectively. ORs were greater in those more recently exposed and those exposed to higher cumulative doses. Conclusion and Relevance: At the population level, use of propulsives, antipsychotics, and flunarizine had a significant association with the increased risk of parkinsonism, depending on recency and cumulative dose. Drugs associated with parkinsonism should be used with careful monitoring to prevent drug-induced parkinsonism.
Collapse
Affiliation(s)
- Siin Kim
- Pusan National University, Busan, South Korea
| | | | - Hae Sun Suh
- Pusan National University, Busan, South Korea
| |
Collapse
|
19
|
Glockler-Lauf SD, Finkelstein Y, Zhu J, Feldman LY, To T. Montelukast and Neuropsychiatric Events in Children with Asthma: A Nested Case-Control Study. J Pediatr 2019; 209:176-182.e4. [PMID: 30905424 DOI: 10.1016/j.jpeds.2019.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between montelukast prescription and neuropsychiatric events in children with asthma. STUDY DESIGN A matched, nested case-control design was used to identify cases and controls from a cohort of children aged 5-18 years with physician-diagnosed asthma from 2004 to 2015, in Ontario, Canada, prescribed an asthma maintenance medication. Cases were children with a hospitalization or emergency department visit for a neuropsychiatric event. Cases were matched to up to 4 controls on birth year, year of asthma diagnosis, and sex. The exposures were dispensed prescriptions for montelukast (yes/no) and number of dispensed montelukast prescriptions in the year before the index date. Conditional logistic regression was used to measure the unadjusted OR and aOR and 95% CIs for montelukast prescription and neuropsychiatric events. Covariates in the adjusted model included sociodemographic factors and measures of asthma severity. RESULTS In total, 898 cases with a neuropsychiatric event and 3497 matched controls were included. Children who experienced a new-onset neuropsychiatric event had nearly 2 times the odds of having been prescribed montelukast, compared with controls (OR 1.91, 95% CI 1.15-3.18; P = .01). Most cases presented for anxiety (48.6%) and/or sleep disturbance (26.1%). CONCLUSIONS Children with asthma who experienced a new-onset neuropsychiatric event had nearly twice the odds of having been prescribed montelukast in the year before their event. Clinicians should be aware of the association between montelukast and neuropsychiatric events in children with asthma, to inform prescribing practices and clinical follow-up.
Collapse
Affiliation(s)
| | - Yaron Finkelstein
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario; Institute for Clinical Evaluative Sciences, Toronto, Ontario; Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario; Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario; Paediatrics, Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario; Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Laura Y Feldman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario; Institute for Clinical Evaluative Sciences, Toronto, Ontario; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
| |
Collapse
|
20
|
Neuropsychiatric Events Associated with Leukotriene-Modifying Agents: A Systematic Review. Drug Saf 2018; 41:253-265. [PMID: 29076063 DOI: 10.1007/s40264-017-0607-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Leukotriene-modifying agents (LTMAs) including montelukast, zafirlukast, and zileuton are approved by the US Food and Drug Administration (FDA) for the treatment of asthma and allergic rhinitis. Various neuropsychiatric events (NEs) have been reported; however, the evidence of the association is conflicting. This systematic review investigates the association between NEs and LTMAs by assessing the relevant published literature. METHODS PubMed, EMBASE, MEDLINE, and Cochrane Library were searched using keywords. Studies designed to investigate the association were eligible for inclusion without restriction to any study design or language. The primary outcome was defined as suicidal conditions, while secondary outcomes included all other NEs. RESULTS Thirty-three studies were included for a narrative review. Four observational studies did not find a significant association, while ten pharmacovigilance studies using different global databases detected the signals. Notably, some studies suggest that the FDA warning issued in 2008 might have influenced the reporting rate of NEs as a result of increased awareness. LIMITATIONS The risk of NEs was not quantified, because of the lack of randomized controlled trials and observational studies investigating the association. CONCLUSION Many pharmacovigilance studies have been conducted to determine the association between NEs and LTMAs, but there is limited evidence from observational studies. High-quality epidemiological studies should be conducted to evaluate the association and quantify the risk, not only in children, but also in adults.
Collapse
|
21
|
Haarman MG, van Hunsel F, de Vries TW. Adverse drug reactions of montelukast in children and adults. Pharmacol Res Perspect 2018; 5. [PMID: 28971612 PMCID: PMC5625152 DOI: 10.1002/prp2.341] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 11/17/2022] Open
Abstract
Montelukast, a selective leukotriene receptor antagonist, is recommended in guidelines for the treatment of asthma in both children and adults. However, its effectiveness is debated, and recent studies have reported several adverse events such as neuropsychiatric disorders and allergic granulomatous angiitis. This study aims to obtain more insight into the safety profile of montelukast and to provide prescribing physicians with an overview of relevant adverse drug reactions in both children and adults. We retrospectively studied all adverse drug reactions on montelukast in children and adults reported to the Netherlands Pharmacovigilance Center Lareb and the WHO Global database, VigiBase® until 2016. Depression was reported most frequently in the whole population to the global database VigiBase® (reporting odds ratio (ROR) 6.93; 95% CI: 6.5–7.4). In the VigiBase®, aggression was reported the most in children (ROR, 29.77; 95% CI: 27.5–32.2). Headaches were reported the most frequently to the Dutch database (ROR, 2.26; 95% CI: 1.61–3.19). Furthermore, nightmares are often reported for both children and adults to the Dutch and the global database. Eight patients with allergic granulomatous angiitis were reported to the Dutch database and 563 patients in the VigiBase®. These data demonstrate that montelukast is associated with neuropsychiatric adverse drug reactions such as depression and aggression. Especially in children nightmares are reported frequently. Allergic granulomatous angiitis is also reported, a causal relationship has not been established.
Collapse
Affiliation(s)
- Meindina G Haarman
- Department of Pediatric Cardiology, Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, The Netherlands
| | | | - Tjalling W de Vries
- Department of Pediatrics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| |
Collapse
|
22
|
Khalid F, Aftab A, Khatri S. The Association Between Leukotriene-Modifying Agents and Suicidality: A Review of Literature. PSYCHOSOMATICS 2017; 59:19-27. [PMID: 28919375 DOI: 10.1016/j.psym.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2008 Food and Drug Administration issued a warning regarding a possible association between leukotriene-modifying agents and suicidality. OBJECTIVE The warning remains controversial and this review of literature is an attempt to examine the evidence on the matter. METHODS Literature search on PubMed. RESULTS The data supporting a relationship between leukotriene-modifying agents and suicidality comes primarily from reviews of individual safety reports in adverse event databases; it is subject to considerable reporting bias and does not control for confounding factors. Case-control and cohort studies as well as data from clinical trials do not support an association between leukotriene-modifying agents and suicidality. The data from ecological studies offers strong evidence of a lack of positive association between leukotriene-modifying agents and suicide outcomes (attempts and deaths) at the population level. Furthermore, there is no pharmacological mechanism that would explain an association between the two. CONCLUSION Overall, the weight of higher quality evidence casts doubt on the association (especially at population level), but is not enough to conclusively disprove the association at an individual level.
Collapse
Affiliation(s)
- Faiza Khalid
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Awais Aftab
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH.
| | - Sumita Khatri
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
23
|
Marcello C, Carlo L. Asthma phenotypes: the intriguing selective intervention with Montelukast. Asthma Res Pract 2016; 2:11. [PMID: 27965779 PMCID: PMC5142440 DOI: 10.1186/s40733-016-0026-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/25/2016] [Indexed: 01/19/2023] Open
Abstract
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation and a variable course associated with various underlying mechanisms that can differ between individuals. Patients with asthma can therefore exhibit different phenotypes, a term used to define the observable characteristics of an organism resulting from the interaction between its genetic makeup and the environment. The heterogeneity of asthma has received a large amount of attention in the last few years in order to better tailor treatment according to the different clinical and biological phenotypes of the disease. Specific asthma phenotypes may require an approach to treatment sometimes different from that recommended by current guidelines, so a personalized approach to asthma pharmacotherapy is recommended. Growing evidence suggests that leukotrienes play an important role in the pathogenesis of bronchial asthma. The mechanisms of action of leukotriene-receptor antagonists theoretically predict a good response in some asthma “phenotypes”.In this article we have performed an analysis of the recent literature (controlled clinical trials and real-life studies) about a possible selective intervention with Montelukast in specific asthma phenotypes.
Collapse
Affiliation(s)
| | - Lombardi Carlo
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, Via Bissolati, 57, 25124 Brescia, Italy
| |
Collapse
|
24
|
Mucke HA. Drug Repurposing Patent Applications April–June 2015. Assay Drug Dev Technol 2015; 13:654-60. [DOI: 10.1089/adt.2015.29030.pq2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|