Document Detail

Tailored second-line therapy in asthmatic children with the Arg(16) genotype.
MedLine Citation:
PMID:  23126384     Owner:  NLM     Status:  MEDLINE    
The Arg(16) β(2) receptor genotype confers increased susceptibility to exacerbations in asthmatic children taking regular LABA (long-acting β(2) agonists). We therefore evaluated using montelukast as an alternative to salmeterol as tailored second-line asthma controller therapy in children expressing this susceptible genotype. A total of 62 persistent asthmatic children with the homozygous Arg16 genotype were randomized to receive salmeterol (50 μg, b.i.d.) or montelukast (5 or 10 mg, once daily) as an add-on to inhaled fluticasone for 1 year. School absences (the primary outcome) were reduced with montelukast compared with salmeterol {difference in score=-0.40 [95% CI (confidence interval), -0.22 to -0.58]; P=0.005}. Salbutamol use was also reduced with montelukast compared with salmeterol [difference in score=-0.47 (95% CI, -0.16 to -0.79); P<0.0001]. Greater improvements occurred in both symptom and quality of life scores with montelukast against salmeterol, whereas there was no difference in FEV(1) (forced expiratory volume in 1 s). In conclusion, montelukast may be suitable as tailored second-line controller therapy instead of salmeterol in asthmatic children expressing the susceptible Arg(16) genotype, a move towards a personalized medicine approach to management.
Brian J Lipworth; Kaninika Basu; Helen P Donald; Roger Tavendale; Donald F Macgregor; Simon A Ogston; Colin N A Palmer; Somnath Mukhopadhyay
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical science (London, England : 1979)     Volume:  124     ISSN:  1470-8736     ISO Abbreviation:  Clin. Sci.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-03-12     Revised Date:  2014-01-13    
Medline Journal Info:
Nlm Unique ID:  7905731     Medline TA:  Clin Sci (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  521-8     Citation Subset:  IM    
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MeSH Terms
Acetates / therapeutic use
Adrenergic beta-2 Receptor Agonists / therapeutic use
Albuterol / analogs & derivatives,  therapeutic use
Amino Acid Motifs
Anti-Asthmatic Agents / therapeutic use*
Arginine / genetics,  metabolism
Asthma / drug therapy*,  genetics,  metabolism
Child, Preschool
Drug Therapy, Combination
Polymorphism, Genetic*
Quinolines / therapeutic use
Receptors, Adrenergic, beta-2 / chemistry,  genetics*,  metabolism
Reg. No./Substance:
0/Acetates; 0/Adrenergic beta-2 Receptor Agonists; 0/Anti-Asthmatic Agents; 0/Quinolines; 0/Receptors, Adrenergic, beta-2; 2I4BC502BT/salmeterol; 94ZLA3W45F/Arginine; MHM278SD3E/montelukast; QF8SVZ843E/Albuterol
Comment In:
Pharmacogenomics. 2013 Dec;14(16):1937-9   [PMID:  24279845 ]
Clin Sci (Lond). 2013 Apr;124(8):517-9   [PMID:  23205695 ]

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