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Is Montelukast efficacious in reducing the symptoms of rhinitis in adult patients?

Is Montelukast efficacious in reducing the symptoms of rhinitis in adult patients?. Table of contents. Introduction. Methods Results References. Table of contents. Introduction Background Research Question Aims. Methods Results References. Backgroud- Rhinitis.

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Is Montelukast efficacious in reducing the symptoms of rhinitis in adult patients?

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  1. Is Montelukast efficacious in reducing the symptoms of rhinitis in adult patients? Introdução à Medicina II

  2. Table of contents • Introduction • Methods • Results • References Introdução à Medicina II

  3. Table of contents • Introduction • Background • Research Question • Aims • Methods • Results • References Introdução à Medicina II

  4. Backgroud- Rhinitis • Inflammation of the nasal mucosa, the mucous membrane lining the nasal cavities. [1] [1] M Ciebiada, Quality of Life in Patients With Persistent Allergic Rhinitis Treated With Montelukast Alone or in Combination With Levocetirizine or Desloratadine, Medical University of Lodz, Department of Pneumology and Allergy, Lodz, Poland Introdução à Medicina II

  5. Backgroud - Rhinitis versus Asthma • Rhinitis and asthma are linked by common epidemiological, clinical and inflammatory features[2] [2] Castillo JA, Navarro A, Quirce S, Molina J, García-Marcos L, Juliá B, Valero A, Mullol J. Prevalence and characteristics of rhinitis in adult asthmatic patients attending allergist, primary care and pulmonologist settings in Spain. Introdução à Medicina II 03-06-2011

  6. Background - Montelukast •Montelukast is a systemically active drug with a targeted, dual mechanism of action, acting both as a bronchodilator and anti-inflammatory[3] •Montelukast is an anti-inflammatory agent that was initially developed as a therapy for asthma and is now increasingly being applied to the treatment of seasonal and perennial allergic rhinitis[4] [3] Diamant Z, Mantzouranis E, Bjermer L. Montelukast in the treatment of asthma and beyond. Department of Allergology. [4] Day JH, Briscoe MP, Ratz JD, Efficacy of levocetirizine compared with montelukast in subjects with ragweed-induced seasonal allergic rhinitis in the Environmental Exposure Introdução à Medicina II

  7. Hypothesis and Research Question Montelukast Is Montelukast efficacious in reducing the symptoms of rhinitis in adult patients compared to placebo and other treatments? Usedinasthmatreatment The treatments of rhinitis and asthma are usually overlapping We want to study Introdução à Medicina II 03-06-2011

  8. Aims • Evaluate the efficacy of Montelukast in reducing symptoms among adults who suffer from rhinitis. • Compare the efficacy of Montelukast in the treatment of rhinitis with the results obtained using conventional anti-rhinitis medication. • Compare the efficacy of Montelukast with the placebo effect • Assess if the simultaneous presence of asthma and rhinitis in a Montelukast treated patient may bring any impact in the drug’s efficacy. Introdução à Medicina II

  9. Table of contents • Introduction • Methods - Flowchart - Systematic review - Study design - Data colection methods - Queries - Articles selection - Variables description • Results • References Introdução à Medicina II

  10. Flowchart Methods and Participants Introdução à Medicina I

  11. Systematic Review • A systematic review is a critical assessment and evaluation of all research studies that address a particular clinical issue. • Selection, evaluation, presentation, analysis and synthesis of evidence. • Aggregation of appropriate and representative results, to achieve an adequate answer. Introdução à Medicina II 03-06-2011

  12. Study Design Adults with concomitant asthma and rhinitis Population Adults with Rhinitis Montelukast Intervention Rhinitis’s conventional medication Placebo Outcome Reducing symptoms Introdução à Medicina I

  13. Data Collection Methods Introdução à Medicina II

  14. Queries ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial (“montelukast “[all fields] OR “Leukotriene Antagonists “[Pharmacological Action]) AND ((“Rhinitis”[tiab]) OR (“Rhinitis, Allergic, Seasonal”[Mesh]) OR (“Rhinitis, Allergic, Perennial”[Mesh])) AND ((Adults [Mesh]) OR (Adults [all fields])) ((clinical[Title/Abstract] AND trial[Title/Abstract]) AND [Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading]) Intervention Disease Population Clinicalquery

  15. Queries Rhinitis AND Montelukast AND Adults Key-word Introdução à Medicina I

  16. ArticlesSelection To be excluded, bothreviewers have to disapprove ISI WEB (17/43) 5 groups 5 groups 271 88 56 14 PUBMED (150/150) First Selection - Title - Abstract After searching full text Second Selection - Full article SCOPUS (104/198) Introdução à Medicina I

  17. ArticlesSelection To be excluded, bothreviewers have to disapprove ISI WEB (17/43) 5 groups 5 groups 271 88 56 14 PUBMED (150/150) First Selection - Title - Abstract After searching full text Second Selection - Full article SCOPUS (104/198) Introdução à Medicina I 03-06-2011

  18. Inclusion and exclusion criteria • Articles over 20 years old • Articles not written in Portuguese, Spanish or English • Sistematic review articles • Study length shorter than two weeks Introdução à Medicina II

  19. Form – First Selection Introdução à Medicina II 03-06-2011

  20. First Selection Results ArticlesSelection ArticlesSelection Introdução à Medicina II

  21. Exclusion Reasons – First Selection Introdução à Medicina I

  22. Form – SecondSelection Introdução à Medicina I

  23. Exclusion Reasons – Second Selection Exclusion reasons Introdução à Medicina I

  24. Our Articles Introdução à Medicina I

  25. Our Articles Introdução à Medicina I

  26. Variables Description Variables Description Introdução à Medicina II

  27. Variables to Be Extracted Treated pathology and other diseases ;Number of study participants, grouped by sex Participants’ characteristics (mean age, gender, etc.) Type of medication taken during the study Unit of measurement and methods of administration Sample Introdução à Medicina I 03-06-2011

  28. Variables to Be Extracted Weight and height of participants and the used measure unit Participants selection method :Type of study and study length Dropouts Results after treatement (side effects and symptoms) Introdução à Medicina I

  29. Comparisons Adults + Rhinitis Adults + Rhinitis + Asthma Without treatment Introdução à Medicina I

  30. Statistical Analysis Meta- Analysis • Meta-analysis is a quantitative synthesis of evidence, using appropriate statistical methodology. Introdução à Medicina I

  31. Gantt Map Gantt Map Introdução à Medicina II

  32. Table of contents • Introduction • Methods • Results • - Database • - Metanalysis • Discussion • References Introdução à Medicina II

  33. Database Database Introdução à Medicina I

  34. Results: A systematic review and Metanalysis In the last presentation … Meta- Analysis Introdução à Medicina I

  35. Results: A systematic review and Metanalysis Now … Meta- Analysis Introdução à Medicina I

  36. Montelukast vs. Placebo Daytime score Nighttime score Composite score

  37. Montelukast vs. Antihistamine Daytime score Nightime score Composite score

  38. Statistical Values Heterogeneity (I2) values were higher than 90% in most cases (only nighttime symptoms with montelukast vs. antihistamine was very low) None of the results was found to be statistically significant, with the lowest value of p being p=0.07 (we considered p<0.05 for significance) Introdução à Medicina I

  39. Qualitative Analysis • Montelukastissignificatively more eficaciousthanthecorticosteroidsinstudy (Baba 2008). • Relatively to N. Sativa,montelukastis more efficacious (p<0.001) inthedaytimescoresymptomsafter 14 days (Ansari 2010). • Incomparisonwithplaceboandantihistamine, wecannotreach a definitiveconclusion, butwedetected a tendency to montelukastbe more efficacious.

  40. Table of contents • Introduction • Methods • Results • Discussion - Limitations - Future perspectives • References Introdução à Medicina II

  41. Discussion Heterogeneity • Number of participants (between 20-521 in each group); • Study lenght (between 3 weeks and 6 months); • Number of total dropouts (between 2-79). Thetypeofstudyandthesecondaryeffectscouldalsobe a heterogeneity factor, butweverifiedthatthere are manymissingvalues for secondaryeffectsandthetypesofstudyaren’tactuallyveryvariable.

  42. Discussion Study Characteristics

  43. Conclusion Meta-analysis performed found no differences between the efficacy of montelukast and conventional medication’s (antihistamines) or placebo’s. However, qualitative analysis suggests there might be a tendency towards montelukast showing better results than its terms of comparison, but in a subtle, unconvincing way. Introdução à Medicina I

  44. Discussion Positive points • We sent e-mails to the authors to obtain the maximum number of full text articles • The articles were reviewed by different researchers and were divided in a random way Introdução à Medicina II

  45. Limitations • Some articles did not have symptom scores evaluation as primary outcome • There is a big diversity of rhinitis treatments, which leads to the presence of many terms of comparison for Montelukast Introdução à Medicina II

  46. Limitations • The efficacy of rhinitis treatments can be controversial • We had to deal with different perspectives during the articles selection • Some of the articles do not have full texts available Introdução à Medicina I

  47. But… Canour project output be generalized or transferred? Population ≠ ≠ Adults Children ElderPeople • Z Adults Children ElderPeople

  48. Future Perspectives • More homogeneity/accordance in values presentation • More articles about rhinitis • New meta-analysis • Studies in other age groups Introdução à Medicina I

  49. SITE Introdução à Medicina I

  50. Table of contents • Introduction • Methods • Results • Discussion • References Introdução à Medicina II

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