title: Leukotriene antagonists in nasal polyposis: a meta-analysis and systematic review.
abstract: BACKGROUND
  Leukotriene antagonists (LTAs) provide a potential strategy for the management of chronic rhinosinusitis with nasal polyposis (CRSwNP), which is often refractory to medical and surgical treatment. The purpose of this study is to determine the impact of LTA treatment alone and in conjunction with intranasal corticosteroids (INCSs) on nasal symptoms, objective clinical outcomes, and immune parameters in CRSwNP.
  
  
  METHODS
  A systematic review was performed including studies that assessed the effectiveness of LTAs on clinical outcome measures of CRSwNP. Exclusion criteria were trials assessing LTAs in CRS without nasal polyps or asthma symptoms only. Quantitative analysis was performed using a random effects model.
  
  
  RESULTS
  Twelve studies fulfilled eligibility: five randomized control trials and seven case series. LTAs showed significant improvements in CRSwNP symptoms over placebo; however, these randomized trials were unable to be combined via meta-analysis. The two studies used in meta-analysis showed a standardized mean difference of pooled overall symptom scores of 0.02 (95% confidence interval, -0.39-0.44) between LTA and INCS study arms, indicating no difference between the treatment modalities. Improvement was described by all studies in symptoms, clinical outcomes, and/or immune parameters after LTA treatment, with greater improvements in a subset of symptoms beyond that observed with INCSs. Concomitant asthma, aspirin-exacerbated respiratory disease, and atopy did not significantly or consistently affect these results.
  
  
  CONCLUSIONS
  LTAs are an effective tool for treating CRSwNP, with limited benefit as an adjunctive therapy. Additional study is required to determine the most beneficial strategy and patient population for their use.
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wentzel
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.forename: Kristen
authors.initials: K
authors.lastname: DeYoung
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: Shivangi
authors.initials: S
authors.lastname: Lohia
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D009298:Nasal Polyps / Q000188:drug therapy* / Q000276:immunology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012220:Rhinitis / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D020024:Leukotriene Antagonists