The Efficacy and Tolerability of Intravenous Montelukast in Acute Asthma Exacerbations in Japanese Patients

Objectives. In Japan, the Asthma Prevention and Management Guidelines recommend nebulized beta-agonists, IV (intravenous) drip corticosteroids, as well as IV drip aminophylline for acute asthma treatment. However, current treatment for acute asthma provides inadequate benefit for some patients. We evaluated the efficacy and safety of IV montelukast added to standard therapy in Japanese patients with acute asthma exacerbations. Methods. This multicenter, randomized, double-blind, parallel-group study compared IV montelukast 7 mg, 14 mg, and placebo in Japanese patients with acute asthma exacerbations (N = 242). Fifteen-to sixty-five-year-old patients with acute asthma were treated with standard care during a screening period that lasted <= 60 minutes. Patients with FEV1 (forced expiratory volume in 1 second) <= 70 predicted were randomly allocated to one of three treatment groups. The primary end point was the time-weighted average change in FEV1 from baseline over 60 minutes [Delta FEV1 (0-60 minutes)] after study drug administration. Secondary end points included the time-weighted average change in FEV1 over 20, 40, and 120 minutes [Delta FEV1 (0-T min)]. Results. IV montelukast 7 mg was significantly more effective than placebo for the time-weighted average Delta FEV1 (0-60 minutes) [least squares (LS) mean 0.09 L vs. 0.01 L; p < .05]. IV montelukast 14 mg was also more effective than placebo (LS mean 0.17 L; p < .001). Similar improvements in time-weighted average [Delta FEV1 (0-T min)] were seen at all time points (all p < .05). Both doses of IV montelukast demonstrated a significant increase in average Delta FEV1 compared with placebo within 10 minutes of administration (p < .001 to p < .01). The tolerability of IV montelukast was similar to that of placebo. Conclusion. IV montelukast was significantly more effective than placebo in the improvement of Delta FEV1 in Japanese patients, suggesting its role as an adjunctive therapy to existing guideline recommendations.