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The leukotriene-receptor antagonist montelukast and the risk of Churg-Strauss syndrome: a case-crossover study
  1. Thomas Hauser (thomas.hauser{at}usz.ch)
  1. Hôpital Cochin, Université Paris 5, Paris, France
    1. Alfred Mahr (amahr{at}bu.edu)
    1. Hôpital Cochin, Université Paris 5, Paris, France
      1. Claudia Metzler (claudia.metzler{at}barmherzige-regensburg.de)
      1. Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
        1. Joel Coste (coste{at}cochin.univ-paris5.fr)
        1. Hôpital Cochin, UniversitéParis 5, Paris, France
          1. Rami Sommerstein (rami.sommerstein{at}spitaeler-ownw.ch)
          1. University Hospital Zurich, Switzerland
            1. Wolfgang L Gross (gross{at}rheuma-zentrum.de)
            1. Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
              1. Loic Guillevin (loic.guillevin{at}cch.aphp.fr)
              1. Hôpital Cochin, Université Paris 5, Paris, France
                1. Bernhard Hellmich (hellmich{at}rheuma-zentrum.de)
                1. Universitätsklinikum Schleswig-Holstein, Lübeck, Germany

                  Abstract

                  Background: There has been some concern that leukotriene-receptor antagonists might precipitate the onset of Churg-Strauss syndrome (CSS). Objective: To investigate the relationship between the leukotriene-receptor antagonist montelukast and CSS onset.

                  Methods: Medication histories of 78 CSS patients from France and Germany were retraced by questioning the patients, treating physicians and dispensing pharmacists, and from medical records. Using a case-crossover research design, we compared exposures to montelukast and other asthma medications during the 3-month 'index' period immediately preceding CSS onset with those of 4 previous 3-month 'control' periods. Odds ratios (OR) were computed by conditional logistic regression.

                  Results: OR (95% CI) for CSS onset were 4.5 (1.5-13.9) for montelukast, 3.0 (0.8-10.5) for inhaled long-acting β2-agonists, 1.7 (0.5-5.4) for inhaled corticosteroids and 4.0 (1.3–12.5) for oral corticosteroids. Montelukast exposure during control periods increased temporally over 3 consecutive calendar periods of CSS onset from 1999 to 2003 (Ptrend <.0001).

                  Conclusion: Montelukast use was associated with a 4.5-fold higher risk of CSS onset within 3 months. However, the positive estimates obtained for other long-term asthma-control medications suggest that this link is confounded by a general escalation of asthma therapy before CSS onset. The montelukast-CSS association observed herein is likely also explained by the increasing use of this medication over time.

                  • Churg–Strauss syndrome
                  • asthma
                  • leukotriene-receptor antagonists
                  • montelukast
                  • pharmacoepidemiology

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