Article
Long term results of the leukotriene antagonist Montelukast in controlling sinunasal polyposis in aspirin triad disease
Kontrolle der Polyposis nasi mit dem Leukotrienrezeptorantagonisten Montelukast bei Patienten mit Analgetikaintoleranz – gehäufte Therapieversager bei Langzeittherapie
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Published: | September 7, 2006 |
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Introduction: Recurrence of nasal polyps after sinus surgery is a common problem in patients with aspirin triad disease (ATD). Overproduction of leukotrienes accounts for the abnormalities in these patients.
Patients and Methods: We present the long term results of 13 patients with ATD, which were treated with Montelukast 10 mg daily after sinus surgery. The duration of follow up ranged from 9 to 84 months (mean: 39). Outcome measures included symptom scores and endoscopic findings.
Results: After follow up duration of 19 months (mean) we found a good local control of sinus symptoms and nasal polyposis in 10 of 13 patients. Only three showed relevant recurrence of polyps (23%). This number of patients increased during further follow up to 61 % within 9 to 84 months (mean: 31). No side effects of Montelukast occurred.
Conclusion: Long term medication of Montelukast showed a remarkable decrease of efficacy in controlling sinunasal polyposis in aspirin triad disease over time. The reasons are unclear.
Review of the latest literature showed a good disease control after desensitization therapy with only low maintenance doses of aspirin and therefore no or only few side effects. By date we recommend Montelukast as standby in cases of unsuccessful desensitization or contraindications and not as first therapy of choice.