Tolerance and rebound with zafirlukast in patients with persistent asthma

Authors

David W. Reid
Neil L. Misso
Shashi Aggarwal
Philip J. Thompson
David P. Johns
E Haydn Walters, University of Notre Dame AustraliaFollow

Publication Details

Reid, D. W., Misso, N. L., Aggarwal, S., Thompson, P. J., Johns, D. P., & Walters. E. H. (2008). Tolerance and rebound with zafirlukast in patients with persistent asthma. Journal of Negative Results in BioMedicine, 7(3), 3. doi:10.1186/1477-5751-7-3

Abstract

Background: The potential for tolerance to develop to zafirlukast, a cysteinyl leukotriene (CysLT) receptor antagonist (LRA) in persistent asthma, has not been specifically examined.

Objective: To look for any evidence of tolerance and potential for short-term clinical worsening on LRA withdrawal. Outcome measures included changes in; airway hyperresponsiveness to inhaled methacholine (PD₂₀FEV₁), daily symptoms and peak expiratory flows (PEF), sputum and blood cell profiles, sputum CysLT and prostaglandin (PG)E₂ and exhaled nitric oxide (eNO) levels.

Methods: A double blind, placebo-controlled study of zafirlukast, 20 mg twice daily over 12 weeks in 21 asthmatics taking β₂-agonists only (Group I), and 24 subjects treated with ICS (Group II).

Results: In Group I, zafirlukast significantly improved morning PEF and compared to placebo (p < 0.01), and reduced morning waking with asthma from baseline after two weeks (p < 0.05). Similarly in Group II, FEV₁ improved compared to placebo (p < 0.05), and there were early within-treatment group improvements in morning PEF, β₂-agonist use and asthma severity scores (p < 0.05). However, most improvements with zafirlukast in Group I and to a lesser extent in Group II deteriorated toward baseline values over 12 weeks. In both groups, one week following zafirlukast withdrawal there were significant deteriorations in morning and evening PEFs and FEV₁ compared with placebo (p ≤ 0.05) and increased nocturnal awakenings in Group II (p < 0.05). There were no changes in PD₂₀FEV₁, sputum CysLT concentrations or exhaled nitric oxide (eNO) levels. However, blood neutrophils significantly increased in both groups following zafirlukast withdrawal compared to placebo (p = 0.007).

Conclusion: Tolerance appears to develop to zafirlukast and there is rebound clinical deterioration on drug withdrawal, accompanied by a blood neutrophilia.

Keywords

peer-reviewed