The Effectiveness of Anti-leukotriene Agents in Patients with COPD: A Systemic Review and Meta-analysis

Jong Hoo Lee, Hyun Jung Kim, Yee Hyung Kim

Anti-leukotriene (anti-LT) agents have been not yet established for effectiveness in patients with chronic obstructive pulmonary disease (COPD). We performed a systematic review and meta-analysis to assess whether anti-LT agents have the responsiveness for COPD patients. MEDLINE, EMBASE, Cochrane Central Register, and Korea Med were searched for relevant clinical trials to review. Seven studies involving 342 patients were finally analyzed. Pooled estimation from three randomized controlled studies did not demonstrate that anti-LT agents increased forced expiratory volume in 1 s [overall effect: 0.09 L, 95 % confidence interval (CI) -0.04 to 0.21; P = 0.17; I (2)  = 41.0 %] or forced vital capacity (overall effect: 0.04 L, 95 % CI -0.04 to 0.11; P = 0.64; I (2) = 0.0 %). As for inflammatory markers, anti-LT agents did not affect the level of myeloperoxidase (standardized mean difference, -0.15; 95 % CI -0.65 to 0.36) or LTB4 (standardized mean difference, -0.41; 95 % CI -0.96 to 0.13). They reduced the frequency of dyspnea [relative risk (RR) 0.43; 95 % CI 0.29 to 0.64] and sputum (RR 0.37; 95 % CI 0.22 to 0.63), based on overall estimation from two non-randomized studies. However, our review revealed that there are few well-designed, randomized controlled studies with large sample sizes and long treatment durations. Although symptomatic improvements were demonstrated in some studies, there is a lack of evidence to support the therapeutic efficacy of anti-LT agents in patients with COPD. Further large-scale, long-term studies are needed to identify predictive factors for COPD patients who may benefit from anti-LT agents.