Although the study demonstrated an 8.53% improvement in baseline
FEV1, the absolute change was 1.85 to 2.01 vs. 1.85 to 1.93 which
is of unclear clinical significance.
While the study demonstrated an 11% absolute risk reduction for
asthma exacerbations, it is important to note that an "exacerbation"
was defined as anything from >70% increased use of MDI's to unexpected
need for hospitalization. While it is clear that the costs
of treating 9 people for 8 weeks clearly outweigh the costs associated
with a hospital admission (particularly if it includes a stay in
the intensive care unit), it is not as clear whether there is a
cost benefit for averting increased use of MDI's or of nocturnal
awakenings. Thus, it is not possible to comment on the cost
effectiveness of this particular treatment given the limited data
in reported in the study.
While the immediate safety profile appears promising, long-term
effects of chronic use are unclear. Thus, it is difficult
to completely endorse this treatment from a side effect point of
Knorr B, Matz J, et al. Montelukast for chronic asthma in
6- to 14-year-old children. A randomized, double-blind trial.
JAMA. 279(15):1181-1187, 1998.