Factors influencing the relative effect of leukotriene receptor antagonists (LTRA) and inhaled corticosteroids (ICS) as monotherapy in persistent asthma: A systematic review
Bibliographic record
Abstract
Objectives: To compare the safety and efficacy of LTRA with ICS in patients with asthma across age groups, over time, baseline severity and ICS dose. Methods: In a systematic review until Dec 2010, we included randomised controlled trials comparing LTRA to ICS for ≥30 days in children and adults with asthma. The primary outcome was exacerbation requiring systemic steroids. Secondary outcomes included lung function, asthma control, adverse effects and withdrawals. Results: The 54 included trials comprised 13,460 patients (2,795 children) with mild (42%) or moderate (58%) airway obstruction. In 84% of trials, LTRA was compared to a low ICS dose over 4-52 weeks. Compared to ICS, 48% more patients treated with LTRA suffered exacerbations requiring systemic steroids (RR 1.48; 95% CI 1.18, 1.85). There was no significant difference in the magnitude of effect between children and adults, ICS dose, and over time. The benefit of ICS over LTRA was greater in patients with moderate vs. mild airway obstruction (RR=2.03 vs. 1.25, p<0.01). FEV1, symptoms, night awakenings, rescue β2-agonist use, symptom-free days, and quality of life favoured ICS at almost points of time. LTRA use was associated with more than a 2-fold increased risk of withdrawals due to poor asthma control (RR 2.58; 95% CI 2.01, 3.30). Both options were equivalent in the risk of overall side effects. Conclusions: ICS remains superior to LTRA to prevent exacerbations and improve asthma control, irrespective of age group, ICS dose, and duration of treatment. However, the benefit of ICS is significantly greater in patients with moderate airway obstruction.
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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 | 0.012 | 0.050 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.013 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 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".