哮喘控制患者递减治疗时导致孟鲁司特治疗失败的危险因素
2011/12/26
摘要
背景：对于低剂量激素吸入（ICS）后哮喘得到很好控制的轻度哮喘患者，采用包括孟鲁司特在内的白三烯受体拮抗剂是哮喘递减治疗的一个选择。由于一些患者存在着孟鲁司特治疗失败，因此，临床医师如果能预测治疗失败的风险，这将对哮喘治疗有所帮助。
目的：研究与孟鲁司特治疗失败相关的患者特征，开发一种临床指标来预测孟鲁司特治疗失败的风险。
方法：入选白三烯/皮质激素/皮质激素-沙美特罗研究（LOCCS）中的165名患者，这些参与者正在采用从低剂量ICS到孟鲁司特的递减治疗。分析入选时患者的一些变量与治疗失败的关系。我们同时构建一种孟鲁司特治疗失败指数来预测递减治疗时孟鲁司特治疗失败的风险。为评价该指标的特异性，在LOCCS 研究的其他治疗组中对其效能进行评价。
结果：与孟鲁司特治疗失败单独相关的患者特征包括：哮喘发作年龄<10岁（OR = 2.39; 95% CI = 1.17-5.02; p =0.018）；过去一年中需要激素冲击治疗（OR = 2.39; 95% CI = 1.13-5.09; p =0.022）；支气管扩张剂使用前第一秒用力呼气体积（FEV1）（每低于预测值的10% OR = 1.44; 95% CI = 1.07-1.97; p =0.016）。基于这三个指标，产生孟鲁司特治疗失败指数（-5～7分）。评分<0表示治疗失败风险较低（<0.20），评分>5表明治疗失败风险较高（>0.60）。
结论：哮喘发作年龄较小、过去1年的哮喘控制较差以及支气管扩张剂使用前FEV1较低与孟鲁司特治疗失败相关。孟鲁司特治疗失败指数能在治疗前对孟鲁司特治疗失败风险进行定量分析。
（苏楠 审校）
J Asthma. 2011 Dec;48(10):1051-1057. Epub 2011 Oct 27.
Risk Factors for Montelukast Treatment Failure in Step-Down Therapy for Controlled Asthma.
Drummond MB, Peters SP, Castro M, Holbrook JT, Irvin CG, Smith LJ, Wise RA, Sugar EA; for the American Lung Association Asthma Clinical Research Center Research Group.
Source
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD , USA .
Abstract
BACKGROUND：Leukotriene receptor antagonists including montelukast are an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Because some patients fail montelukast step-down therapy, it would be helpful for clinicians to be able to predict the risk of treatment failure.
OBJECTIVES：To determine patient characteristics associated with montelukast treatment failure and develop a clinical index to predict the risk of montelukast treatment failure.
METHODS：Using the 165 participants in the Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial who were stepped down from low-dose ICS to montelukast, we determined associations between enrollment variables and treatment failure. We constructed a montelukast failure index to predict the risk of montelukast treatment failure during step-down. To assess its specificity for montelukast, index performance was evaluated in the other LOCCS treatment groups.
RESULTS：Characteristics independently associated with montelukast treatment failure included age of asthma onset <10 years old (OR = 2.39; 95% CI = 1.17-5.02; p = .018), need for steroid burst in the last year (OR = 2.39; 95% CI = 1.13-5.09; p = .022), and pre-bronchodilator forced expiratory volume in 1 s (FEV(1)) (OR = 1.44 per 10% lower % predicted; 95% CI = 1.07-1.97; p = .016). A montelukast failure index was generated from these three variables (range: -5 to 7 points). Scores <0 predicted low risk (<0.20) of treatment failure, whereas scores >5 predicted high risk (>0.60) of treatment failure.
CONCLUSION：Early asthma onset, worse asthma control in the last year, and lower pre-bronchodilator FEV(1) are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation.
J Asthma. 2011 Dec;48(10):1051-1057. Epub 2011 Oct 27.
背景：对于低剂量激素吸入（ICS）后哮喘得到很好控制的轻度哮喘患者，采用包括孟鲁司特在内的白三烯受体拮抗剂是哮喘递减治疗的一个选择。由于一些患者存在着孟鲁司特治疗失败，因此，临床医师如果能预测治疗失败的风险，这将对哮喘治疗有所帮助。
目的：研究与孟鲁司特治疗失败相关的患者特征，开发一种临床指标来预测孟鲁司特治疗失败的风险。
方法：入选白三烯/皮质激素/皮质激素-沙美特罗研究（LOCCS）中的165名患者，这些参与者正在采用从低剂量ICS到孟鲁司特的递减治疗。分析入选时患者的一些变量与治疗失败的关系。我们同时构建一种孟鲁司特治疗失败指数来预测递减治疗时孟鲁司特治疗失败的风险。为评价该指标的特异性，在LOCCS 研究的其他治疗组中对其效能进行评价。
结果：与孟鲁司特治疗失败单独相关的患者特征包括：哮喘发作年龄<10岁（OR = 2.39; 95% CI = 1.17-5.02; p =0.018）；过去一年中需要激素冲击治疗（OR = 2.39; 95% CI = 1.13-5.09; p =0.022）；支气管扩张剂使用前第一秒用力呼气体积（FEV1）（每低于预测值的10% OR = 1.44; 95% CI = 1.07-1.97; p =0.016）。基于这三个指标，产生孟鲁司特治疗失败指数（-5～7分）。评分<0表示治疗失败风险较低（<0.20），评分>5表明治疗失败风险较高（>0.60）。
结论：哮喘发作年龄较小、过去1年的哮喘控制较差以及支气管扩张剂使用前FEV1较低与孟鲁司特治疗失败相关。孟鲁司特治疗失败指数能在治疗前对孟鲁司特治疗失败风险进行定量分析。
（苏楠 审校）
J Asthma. 2011 Dec;48(10):1051-1057. Epub 2011 Oct 27.
Risk Factors for Montelukast Treatment Failure in Step-Down Therapy for Controlled Asthma.
Drummond MB, Peters SP, Castro M, Holbrook JT, Irvin CG, Smith LJ, Wise RA, Sugar EA; for the American Lung Association Asthma Clinical Research Center Research Group.
Source
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, MD , USA .
Abstract
BACKGROUND：Leukotriene receptor antagonists including montelukast are an option for step-down therapy for mild asthmatics controlled on low-dose inhaled corticosteroids (ICS). Because some patients fail montelukast step-down therapy, it would be helpful for clinicians to be able to predict the risk of treatment failure.
OBJECTIVES：To determine patient characteristics associated with montelukast treatment failure and develop a clinical index to predict the risk of montelukast treatment failure.
METHODS：Using the 165 participants in the Leukotriene or Corticosteroid or Corticosteroid-Salmeterol Study (LOCCS) trial who were stepped down from low-dose ICS to montelukast, we determined associations between enrollment variables and treatment failure. We constructed a montelukast failure index to predict the risk of montelukast treatment failure during step-down. To assess its specificity for montelukast, index performance was evaluated in the other LOCCS treatment groups.
RESULTS：Characteristics independently associated with montelukast treatment failure included age of asthma onset <10 years old (OR = 2.39; 95% CI = 1.17-5.02; p = .018), need for steroid burst in the last year (OR = 2.39; 95% CI = 1.13-5.09; p = .022), and pre-bronchodilator forced expiratory volume in 1 s (FEV(1)) (OR = 1.44 per 10% lower % predicted; 95% CI = 1.07-1.97; p = .016). A montelukast failure index was generated from these three variables (range: -5 to 7 points). Scores <0 predicted low risk (<0.20) of treatment failure, whereas scores >5 predicted high risk (>0.60) of treatment failure.
CONCLUSION：Early asthma onset, worse asthma control in the last year, and lower pre-bronchodilator FEV(1) are associated with montelukast treatment failure. A montelukast failure index is proposed to quantify the risk of failure prior to treatment initiation.
J Asthma. 2011 Dec;48(10):1051-1057. Epub 2011 Oct 27.
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