In children with asthma who are currently using inhaled corticosteroids, are antileukotrienes more effective than placebo in improving clinical outcomes?
Bibliographic record
Abstract
The current literature suggests that antileukotrienes are effective in decreasing beta2-agonists use, decreasing asthma exacerbation days and improving some aspects of spirometry. However, antileukotrienes do not seem to be effective in decreasing the use of oral steroids in patients with asthma (Grade of recommendation: A, based on an individual randomized controlled trial and systematic review of randomized controlled trials [1]). It should be noted that the answer to this question is complicated by a number of issues. Ducharme et al (2) completed a systematic review of all randomized controlled trials up to August 2001, examining the use of antileukotrienes as add-on therapy to inhaled corticosteroids. Ducharme's review was of strong methodological quality, using only randomized controlled trials found by thorough and comprehensive searching techniques, and using quality assessments of each trial. Of the thirteen trials included in this review, only one trial examined the use of antileukotrienes in children. The primary outcome of Ducharme's review, asthma exacerbations requiring oral steroids, was examined in three types of situations. First, antileukotrienes and placebo were compared when added to an unchanged dosage of inhaled steroids. In the second situation, antileukotrienes were compared to a doubled dose of inhaled steroids. Finally, antileukotrienes were compared against placebo when added to a schedule of tapered steroid doses. In the first situation, the addition of antileukotrienes at licensed doses to unchanging doses of inhaled steroids did not decrease the rate of episodes requiring oral steroids. However, antileukotrienes did modestly increase peak expiratory flows (PEF) and decrease the use of beta2-agonists. When compared with doubled doses of inhaled steroids in the second situation, high doses of antileukotrienes did not show any advantage in reducing the use of systemic steroids, nor did they decrease the use of beta2-agonists, hospital admissions or improve forced expiratory volumes in one second (FEV1) when compared with inhaled steroids. Finally, antileukotrienes, when added to a regime of tapering inhaled steroids, may possibly enhance asthma control over placebo as evidenced by a significant reduction in withdrawals due to worsening symptoms of asthma. However, the actual steroid-sparing effect of antileukotrienes could not be quantified due to the small number of trials and the heterogeneity of results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.050 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.007 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".