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. 2021 Mar 17;7(1):4.
doi: 10.1186/s40733-021-00070-4.

The role of leukotriene modifying agent treatment in neuropsychiatric events of elderly asthma patients: a nested case control study

Sang Oh Kang #  1 , Kyung Hyun Min #  1 , Hyun Jeong Kim  1 , Tae Hyeok Kim  1 , Woorim Kim  1 , Kyung Eun Lee  2
Affiliations

The role of leukotriene modifying agent treatment in neuropsychiatric events of elderly asthma patients: a nested case control study

Sang Oh Kang et al. Asthma Res Pract. .

Abstract

Background: In March 2020, the US Food and Drug Administration decided that the dangers related to neuropsychiatric events (NPEs) of montelukast, one of the leukotriene modifying agents (LTMAs), should be communicated through 'boxed warning'. In case of NPEs, the prevalence has been the highest in elderly people. Because the characteristics of the elderly such as old age itself can act as risk factors. Therefore, an investigation on safety of LTMAs related to NPEs in elderly using LTMAs is needed.

Method: A nested case-control study using an elderly sample cohort from the Korean National Health Insurance Service database was used. The asthma cohort included asthma patients newly diagnosed between 2003 and 2013. Within the asthma cohort, the case group was defined as patients who were diagnosed with NPEs. Among patients who had never been diagnosed with NPEs, the control group was selected by matching 1:1 by propensity score. Patients who were prescribed LTMAs for 1 year prior to index date were defined as the exposure group. The logistic regression model was used to measure the effect of LTMAs on NPEs.

Results: We identified 141,165 patients with newly diagnosed asthma, and selected 31,992 patients per each case and control group. Exposure to LTMAs significantly increased the risk of overall NPEs about in comparison with the absence of exposure (crude odds ratio [OR] 1.58, 95% CI 1.50-1.68). After adjusting for confounding factors, the overall NPEs risk increased (adjusted OR, 1.67, 95% CI 1.58-1.78).

Conclusion: This study suggests that elderly asthma patients prescribed LTMAs had a higher risk of NPEs than patients who were not treated with LTMAs. Therefore, clinicians should be aware of the potential risks of LTMAs.

Keywords: Asthma; Leukotriene modifying agent; National health insurance service database; Nested case-control study; Neuropsychiatric events; South Korea.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Selection of the case and control group, and exposed and non-exposed groups. Abbreviation: NPE Neuropsychiatric Event
See this image and copyright information in PMC

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