Evidence map›Paper›PMID 35105629›Full record

SynthesisBMJ open2022

Deprescribing montelukast in children with asthma: a systematic review.

Eleanor Grace Dixon, Charlotte King, Andrew Lilley, Ian P Sinha, Daniel B Hawcutt

Abstract readSystematic Review
In one paragraph

Synthesis in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Eleanor Grace DixonDepartment of Pharmacology and Therapeutics, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK.ORCID 0000-0001-9697-0068
Charlotte KingRoyal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Andrew LilleyDepartment of Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Ian P SinhaAlder Hey Children's NHS Foundation Trust, Liverpool, UK.
Daniel B HawcuttDepartment of Women's and Children's Health, University of Liverpool, Liverpool, UK dhawcutt@liverpool.ac.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNational and international asthma guidelines recommend adjusting asthma treatment based on levels of control, yet no guidance is given regarding the stepping-down of montelukast in children and young people (CYP).

objectiveTo systematically review evidence regarding deprescribing montelukast in CYP with established asthma.

designSystematic review. DATA SOURCES: Embase, Medline, PubMed and CINAHL were searched up to October 2020. STUDY SELECTION: Eligible studies contained patients aged 0-18 years with a diagnosis of asthma, who had been administering montelukast before it was withdrawn. All reasons for withdrawal were included.

resultsThe search identified 197 papers. After deduplication, five papers were included (three randomised control studies and two cohort studies). Four studies observed the impact of montelukast withdrawal for 2 weeks, and one study for 8 weeks. The impact of withdrawal was measured in the studies using a combination of lung tests (eg, forced expiratory volume in 1 s (FEV1), fractional exhaled nitric oxide (FeNO)), asthma scoring methods and exercise challenges. Of the 17 domains in the Core Outcome Set for Clinical Trials in Childhood Asthma, eight outcomes were measured in at least one of the five studies, with all five studies measuring the outcome of 'Lung Function'. No significant differences were found between the montelukast and placebo groups following montelukast withdrawal. Significant differences between the comparator points within the test group were found in nine outcomes across four studies; FEV1/forced vital capacity, FEV1, forced expiratory flows (25%-75%), asthma score (study specific), maximum % fall in FEV1 and time to recovery (post exercise) significantly decreased whereas FEV1/bronchodilator response, FeNO and eNO significantly increased.

conclusionOnly limited, contradictory and short-term effects of deprescribing montelukast in CYP with established asthma are presented in literature. Definitive studies determining clinical stability, and impact of deprescribing montelukast in CYP are imperative to improve the safety of asthma treatment in CYP. PROSPERO REGISTRATION NUMBER: CRD42020213971.

Indexed as

Anti-Asthmatic AgentsAsthmaDeprescriptionsAcetatesAdolescentChildChild, PreschoolCyclopropanesForced Expiratory VolumeHumansInfantInfant, NewbornQuinolinesSulfidesAcetatesAnti-Asthmatic AgentsCyclopropanesmontelukastQuinolinesSulfidesasthmaclinical pharmacologypaediatrics

Identifiers

PMID35105629
PMCPMC8804657

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.