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Asthma
The leucotriene receptor antagonist montelukast and the risk of Churg-Strauss syndrome: a case–crossover study
  1. T Hauser1,2,
  2. A Mahr1,3,
  3. C Metzler4,
  4. J Coste3,
  5. R Sommerstein2,
  6. W L Gross4,
  7. L Guillevin1,
  8. B Hellmich4
  1. 1
    Department of Internal Medicine, for the French Vasculitis Study Group (FVSG), Hôpital Cochin, Université Paris 5, Paris, France
  2. 2
    Division of Clinical Immunology, Department of Internal Medicine, University Hospital, Zurich, Switzerland
  3. 3
    Department of Biostatistics, Hôpital Cochin, Université Paris 5, Paris, France
  4. 4
    Rheumaklinik Bad Bramstedt, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
  1. Dr A Mahr, Department of Internal Medicine, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France; alfred.mahr{at}cch.aphp.fr

Abstract

Background: There has been some concern that leucotriene receptor antagonists might precipitate the onset of Churg-Strauss syndrome (CSS). A study was undertaken to investigate the relationship between the leucotriene receptor antagonist montelukast and the onset of CSS.

Methods: Medication histories of 78 patients with CSS 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, exposures to montelukast and other asthma medications during the 3-month “index” period immediately preceding the onset of CSS were compared with those of four previous 3-month “control” periods. Odds ratios (ORs) were computed by conditional logistic regression.

Results: The ORs for CSS onset were 4.5 (95% CI 1.5 to 13.9) for montelukast, 3.0 (95% CI 0.8 to 10.5) for inhaled long-acting β2 agonists, 1.7 (95% CI 0.5 to 5.4) for inhaled corticosteroids and 4.0 (95% CI 1.3 to 12.5) for oral corticosteroids. Montelukast exposure during control periods increased temporally over three consecutive calendar periods of CSS onset from 1999 to 2003 (ptrend <0.0001).

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 might be confounded by a general escalation of asthma therapy before CSS onset. The association between montelukast and CSS observed in this study is probably also explained by the increasing use of this medication over time.

https://doi.org/10.1136/thx.2007.087825

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    Footnotes

    • TH and AM contributed equally to this work.

    • Funding: This study received a grant from the GIS–Institut des Maladies Rares, Paris, France. AM was supported in part by a Vasculitis Clinical Investigator Fellowship from the Vasculitis Clinical Research Consortium (VCRC) through a grant from the National Institutes of Health (National Center for Research Resources and the National Institute of Arthritis and Musculoskeletal and Skin Diseases) (NIH-NCRR: U54 RR019497).

    • Competing interests: None.

    • Ethics approval: The study protocol was reviewed and approved by the Commission Nationale de l’Informatique et des Libertés in France and the ethics committee of the University of Lübeck in Germany. All patients gave written informed consent to participate in the study.