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A systematic review on the off-label use of montelukast in atopic dermatitis treatment

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Abstract

Background Atopic dermatitis (AD) is the most common form of eczema. As leukotriene mediators are involved in the inflammatory phase of atopic dermatitis, montelukast has been suggested as a possible therapy. Aim of the review To evaluate the safety and efficacy of montelukast off-label use for the treatment atopic dermatitis. Method A search was performed from database inception until March 2018 in six electronic databases for randomized-controlled-trials examining the use of montelukast for AD. Results Among 301 articles screened, 11 studies met the inclusion criteria and were included in the review. The study populations consist of paediatric and adult subjects with moderate-to-severe AD. Montelukast use was shown to improve symptoms such as pruritus in four studies. Another 2 studies reported that montelukast could improve symptoms similar to the standard regimen of topical steroid and oral antihistamine. However, five studies reported that montelukast had no effects in symptoms alleviation. The use of montelukast was associated with a similar safety profile to placebo and well-tolerated with minimal adverse effects. Conclusion There is limited evidence to suggest that the off-label use of montelukast is effective in treating moderate-to-severe AD. Further research with larger study populations employing standardized endpoint measuring instrument is warranted to further investigate the off-label use of montelukast in AD treatment. Until then, the use of conventional treatments including optimal daily skin hydration should remain the mainstay in the management of atopic dermatitis. In fact, for moderate-to-severe condition, steroid sparing immune-suppressants should still be used clinically until more effective and safer alternative is discovered.

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Abbreviations

AD:

Atopic dermatitis

RCTs:

Randomized rontrolled trials

LTRA:

Cysteinyl-leukotriene-1 receptor antagonist

IgE:

Immunoglobulin E

LTs:

Leukotrienes

SCORAD:

Severity Scoring of Atopic Dermatitis

SASSAD:

Six Area, Six Sign Atopic Dermatitis

EASI:

Eczema Area and Severity Index

ADASI:

Atopic Dermatitis Area and Severity Index

IGA:

Investigators’ Global Assessment

LTE4:

Leukotriene E4

EDN/EPX:

Eosinophil-derived neurotoxin/eosinophilic protein X

ECP:

Eosinophilic cationic protein

QoL:

Quality of life

CDLQI:

Children’s Dermatology Life Quality Index

CBC:

Complete blood count

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This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia

    Weng Khong Chin & Shaun Wen Huey Lee

  2. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia

    Shaun Wen Huey Lee

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Correspondence to Weng Khong Chin.

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Chin, W.K., Lee, S.W.H. A systematic review on the off-label use of montelukast in atopic dermatitis treatment. Int J Clin Pharm 40, 963–976 (2018). https://doi.org/10.1007/s11096-018-0655-3

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