The Arg16 β2 receptor genotype confers increased susceptibility to exacerbations in asthmatic children taking regular LABA (long-acting β2 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 FEV1 (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 Arg16 genotype, a move towards a personalized medicine approach to management.
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April 2013
Research Article|
January 08 2013
Tailored second-line therapy in asthmatic children with the Arg16 genotype
Brian J. Lipworth;
*Asthma and Allergy Research Group, Division of Medicine and Therapeutics, University of Dundee, Dundee DD2 4BF, Scotland, U.K.
Correspondence: Dr Brian J. Lipworth (email b.j.lipworth@dundee.ac.uk).
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Kaninika Basu;
Kaninika Basu
†Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton and Sussex Medical School, Brighton BN2 5BE, U.K.
‡Children's Asthma and Allergy Unit, Perth Royal Infirmary, NHS Tayside, University of Dundee, Perth PH1 1NX, Scotland, U.K.
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Helen P. Donald;
Helen P. Donald
‡Children's Asthma and Allergy Unit, Perth Royal Infirmary, NHS Tayside, University of Dundee, Perth PH1 1NX, Scotland, U.K.
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Roger Tavendale;
Roger Tavendale
§Population Pharmacogenetics Group, Biomedical Research Institute, University of Dundee, Dundee DD2 4BF, Scotland, U.K.
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Donald F. Macgregor;
Donald F. Macgregor
‡Children's Asthma and Allergy Unit, Perth Royal Infirmary, NHS Tayside, University of Dundee, Perth PH1 1NX, Scotland, U.K.
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Simon A. Ogston;
Simon A. Ogston
∥Division of Clinical and Population Sciences and Education, University of Dundee, Dundee DD2 4BF, Scotland, U.K.
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Colin N. A. Palmer;
Colin N. A. Palmer
§Population Pharmacogenetics Group, Biomedical Research Institute, University of Dundee, Dundee DD2 4BF, Scotland, U.K.
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Somnath Mukhopadhyay
Somnath Mukhopadhyay
†Academic Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton and Sussex Medical School, Brighton BN2 5BE, U.K.
‡Children's Asthma and Allergy Unit, Perth Royal Infirmary, NHS Tayside, University of Dundee, Perth PH1 1NX, Scotland, U.K.
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Clin Sci (Lond) (2013) 124 (8): 521–528.
Article history
Received:
October 01 2012
Revision Received:
October 23 2012
Accepted:
November 05 2012
Accepted Manuscript online:
November 05 2012
Connected Content
This is a commentary on:
A tailored approach to asthma management: Arg16 holds the key?
Citation
Brian J. Lipworth, Kaninika Basu, Helen P. Donald, Roger Tavendale, Donald F. Macgregor, Simon A. Ogston, Colin N. A. Palmer, Somnath Mukhopadhyay; Tailored second-line therapy in asthmatic children with the Arg16 genotype. Clin Sci (Lond) 1 April 2013; 124 (8): 521–528. doi: https://doi.org/10.1042/CS20120528
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