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Tailored second line therapy in asthmatic children with the arginine-16 genotype

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posted on 2023-06-08, 14:03 authored by Brian J Lipworth, Kaninika Basu, Helen P Donald, Roger Tavendale, Donald F Macgregor, Simon A Ogston, Colin N A Palmer, Somnath MukhopadhyaySomnath Mukhopadhyay
The arginine-16 beta-2 receptor genotype confers increased susceptibility to exacerbations in asthmatic children taking regular long acting beta-2 agonists. We therefore evaluated using montelukast as an alternative to salmeterol as tailored second line asthma controller therapy in children expressing this susceptible genotype. 62 persistent asthmatic children with the homozygous arginine-16 genotype were randomized to receive salmeterol 50ug bid or montelukast 5/10mg od as add on to inhaled fluticasone for 1 year. School absences (the primary outcome) were reduced with montelukast arm compared to salmeterol: difference in score = 0.40 (95%CI 0.07-0.87) p=0.005. Albuterol use was also reduced with montelukast compared with salmeterol: difference in score = 0.47 (95%CI 0.16-0.79) p<0.0001. Greater improvements occurred in both symptom and quality of life scores with montelukast vs salmeterol, while there was no difference in FEV1. Montelukast may be suitable as tailored second line controller therapy instead of salmeterol in asthmatic children expressing the susceptible arginine-16 genotype - moving towards a personalised medicine approach to management.

History

Publication status

  • Published

File Version

  • Accepted version

Journal

Clinical Science

ISSN

0143-5221

Publisher

Portland Press

Issue

8

Volume

124

Page range

521-528

Department affiliated with

  • Clinical and Experimental Medicine Publications

Notes

Online first publication

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2013-01-08

First Open Access (FOA) Date

2013-05-05

First Compliant Deposit (FCD) Date

2013-01-08

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