Efficacy and safety of salmeterol/fluticasone compared with montelukast alone (or add-on therapy to fluticasone) in the treatment of bronchial asthma in children and adolescents: a systematic review and meta-analysis  

作　　者：Xiao-Jian Zhou Zhen Qin Jiao Lu Jian-Guo Hong 

机构地区：[1]Department of Paediatrics,Shanghai General Hospital,Shanghai Jiaotong University,Shanghai 200080,China

出　　处：《Chinese Medical Journal》2021年第24期2954-2961,共8页中华医学杂志（英文版）

摘　　要：Background:Despite the recommendation of inhaled corticosteroids(ICSs)plus long-acting beta 2-agonist(LABA)and leukotriene receptor antagonist(LTRA)or ICS/LTRA as stepwise approaches in asthmatic children,there is a lack of published systematic review comparing the efficacy and safety of the two therapies in children and adolescents aged 4 to 18 years.This study aimed to compare the safety and efficacy of salmeterol/fluticasone(SFC)vs.montelukast(MON),or combination of montelukast and fluticasone(MFC)in children and adolescents aged 4 to 18 years with bronchial asthma.Methods:A systematic search was conducted in MEDLINE,EMBASE,the Cochrane Library,China BioMedical Literature Database,Chinese National Knowledge Infrastructure,VIP Database for Chinese Technical Periodical,and Wanfang for randomized controlled trials(RCTs)published from inception to May 24,2021.Interventions are as follows:SFC vs.MON,or combination of MFC,with no limitation of dosage or duration.Primary and secondary outcome measures were as follows:the primary outcome of interest was the risk of asthma exacerbation.Secondary outcomes included risk of hospitalization,pulmonary function,asthma control level,quality of life,and adverse events(AEs).A random-effects(I^(2)≥50%)or fixed-effects model(I^(2)<50%)was used to calculate pooled effect estimates,comparing the outcomes between the intervention and control groups where feasible.Results:Of the 1006 articles identified,21 studies met the inclusion criteria with 2643 individuals;two were at low risk of bias.As no primary outcomes were similar after an identical treatment duration in the included studies,meta-analysis could not be performed.However,more studies favored SFC,instead of MON,owing to a lower risk of asthma exacerbation in the SFC group.As for secondary outcome,SFC showed a significant improvement of peak expiratory flow(PEF)%pred after 4 weeks compared with MFC(mean difference[MD]:5.45;95%confidence interval[CI]:1.57-9.34;I^(2)=95%;P=0.006).As for asthma control level,SFC also showed a

关 键 词：Bronchial asthma Fluticasone/salmeterol MONTELUKAST Systematic review Pediatric 

分 类 号：R725.6[医药卫生—儿科]