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Montelukast or salmeterol combined with an inhaled steroid in adult asthma: design and rationale of a randomized, double-blind comparative study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial).
Respir Med. 2000 Jun; 94(6):612-21.RM

Abstract

Asthma patients who continue to experience symptoms despite taking regular inhaled corticosteroids represent a management challenge. Leukotrienes play a key role in asthma pathophysiology, and since pro-inflammatory leukotrienes are poorly suppressed by corticosteroids it seems rational to add a leukotriene receptor antagonist (LTRA) when a low to moderate dose of inhaled corticosteroids does not provide sufficient disease control. Long acting beta2-agonist (LABA) treatment represents an alternative to LTRAs and both treatment modalities have been shown to provide additional disease control when added to corticosteroid treatment. To compare the relative clinical benefits of adding either a LTRA or a LABA to asthma patients inadequately controlled by inhaled corticosteroids, a randomized, double-blind, multi-centre, 48-week study will be initiated at approximately 120 centres throughout Europe, Latin America, Middle East, Africa and the Asia-Pacific region in early 2000. The study will compare the oral LTRA montelukast with the inhaled LABA salmeterol, each administered on a background of inhaled fluticasone, on asthma attacks, quality of life, lung function, eosinophil levels, healthcare utilization, and safety, in approximately 1200 adult asthmatic patients. The requirements for study enrollment include a history of asthma, FEV1 or PEFR values between 50% and 90% of the predicted value together with > or = 12% improvement in FEV1 after beta-agonist administration, a minimum pre-determined level of asthma symptoms and daily beta-agonist medication. The study will include a 4-week run-in period, during which patients previously taking inhaled corticosteroids are switched to open-label fluticasone (200 microg daily), followed by a 48-week double-blind, treatment period in which patients continuing to experience abnormal pulmonary function and daytime symptoms are randomized to receive montelukast (10 mg once daily) and salmeterol placebo, or inhaled salmeterol (100 microg daily) and montelukast placebo. All patients will continue with inhaled fluticasone (200 microg daily). During the study, asthma attacks, overnight asthma symptoms, and morning peak expiratory flow rate will be assessed using patient diary cards; quality of life will also be assessed using an asthma-specific quality-of life questionnaire. The results of this study are expected to provide physicians with important clinical evidence to help them make a rational and logical treatment choice for asthmatic patients experiencing breakthrough symptoms on inhaled corticosteroids.

Authors+Show Affiliations

Department of Lung Medicine, University Hospital, Trondheim, Norway. Leif.Bjermer@medisin.ntnu.noNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10921768

Citation

Bjermer, L, et al. "Montelukast or Salmeterol Combined With an Inhaled Steroid in Adult Asthma: Design and Rationale of a Randomized, Double-blind Comparative Study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial)." Respiratory Medicine, vol. 94, no. 6, 2000, pp. 612-21.
Bjermer L, Bisgaard H, Bousquet J, et al. Montelukast or salmeterol combined with an inhaled steroid in adult asthma: design and rationale of a randomized, double-blind comparative study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial). Respir Med. 2000;94(6):612-21.
Bjermer, L., Bisgaard, H., Bousquet, J., Fabbri, L. M., Greening, A., Haahtela, T., Holgate, S. T., Picado, C., & Leff, J. A. (2000). Montelukast or salmeterol combined with an inhaled steroid in adult asthma: design and rationale of a randomized, double-blind comparative study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial). Respiratory Medicine, 94(6), 612-21.
Bjermer L, et al. Montelukast or Salmeterol Combined With an Inhaled Steroid in Adult Asthma: Design and Rationale of a Randomized, Double-blind Comparative Study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial). Respir Med. 2000;94(6):612-21. PubMed PMID: 10921768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Montelukast or salmeterol combined with an inhaled steroid in adult asthma: design and rationale of a randomized, double-blind comparative study (the IMPACT Investigation of Montelukast as a Partner Agent for Complementary Therapy-trial). AU - Bjermer,L, AU - Bisgaard,H, AU - Bousquet,J, AU - Fabbri,L M, AU - Greening,A, AU - Haahtela,T, AU - Holgate,S T, AU - Picado,C, AU - Leff,J A, PY - 2000/8/2/pubmed PY - 2000/8/19/medline PY - 2000/8/2/entrez SP - 612 EP - 21 JF - Respiratory medicine JO - Respir Med VL - 94 IS - 6 N2 - Asthma patients who continue to experience symptoms despite taking regular inhaled corticosteroids represent a management challenge. Leukotrienes play a key role in asthma pathophysiology, and since pro-inflammatory leukotrienes are poorly suppressed by corticosteroids it seems rational to add a leukotriene receptor antagonist (LTRA) when a low to moderate dose of inhaled corticosteroids does not provide sufficient disease control. Long acting beta2-agonist (LABA) treatment represents an alternative to LTRAs and both treatment modalities have been shown to provide additional disease control when added to corticosteroid treatment. To compare the relative clinical benefits of adding either a LTRA or a LABA to asthma patients inadequately controlled by inhaled corticosteroids, a randomized, double-blind, multi-centre, 48-week study will be initiated at approximately 120 centres throughout Europe, Latin America, Middle East, Africa and the Asia-Pacific region in early 2000. The study will compare the oral LTRA montelukast with the inhaled LABA salmeterol, each administered on a background of inhaled fluticasone, on asthma attacks, quality of life, lung function, eosinophil levels, healthcare utilization, and safety, in approximately 1200 adult asthmatic patients. The requirements for study enrollment include a history of asthma, FEV1 or PEFR values between 50% and 90% of the predicted value together with > or = 12% improvement in FEV1 after beta-agonist administration, a minimum pre-determined level of asthma symptoms and daily beta-agonist medication. The study will include a 4-week run-in period, during which patients previously taking inhaled corticosteroids are switched to open-label fluticasone (200 microg daily), followed by a 48-week double-blind, treatment period in which patients continuing to experience abnormal pulmonary function and daytime symptoms are randomized to receive montelukast (10 mg once daily) and salmeterol placebo, or inhaled salmeterol (100 microg daily) and montelukast placebo. All patients will continue with inhaled fluticasone (200 microg daily). During the study, asthma attacks, overnight asthma symptoms, and morning peak expiratory flow rate will be assessed using patient diary cards; quality of life will also be assessed using an asthma-specific quality-of life questionnaire. The results of this study are expected to provide physicians with important clinical evidence to help them make a rational and logical treatment choice for asthmatic patients experiencing breakthrough symptoms on inhaled corticosteroids. SN - 0954-6111 UR - https://www.unboundmedicine.com/medline/citation/10921768/Montelukast_or_salmeterol_combined_with_an_inhaled_steroid_in_adult_asthma:_design_and_rationale_of_a_randomized_double_blind_comparative_study__the_IMPACT_Investigation_of_Montelukast_as_a_Partner_Agent_for_Complementary_Therapy_trial__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(00)90806-0 DB - PRIME DP - Unbound Medicine ER -