Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review
Abstract Background Very preterm infants are at high risk of developing chronic lung disease, which requires respiratory support and might have long-term sequelae. As lung inflammation plays an important role in pathogenesis, antileukotrienes have been explored in both clinical and animal studies. W...
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12931-021-01800-1 |
| _version_ | 1818648834989883392 |
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| author | Marlide Jukema Franciszek Borys Greta Sibrecht Karsten Juhl Jørgensen Matteo Bruschettini |
| author_facet | Marlide Jukema Franciszek Borys Greta Sibrecht Karsten Juhl Jørgensen Matteo Bruschettini |
| author_sort | Marlide Jukema |
| collection | DOAJ |
| description | Abstract Background Very preterm infants are at high risk of developing chronic lung disease, which requires respiratory support and might have long-term sequelae. As lung inflammation plays an important role in pathogenesis, antileukotrienes have been explored in both clinical and animal studies. We aimed to assess the benefits and harms of antileukotrienes for the prevention and treatment of respiratory morbidity and mortality in very preterm newborns. Methods In this systematic review, we included randomized trials and non-randomized studies in humans and animals reporting the effects of antileukotrienes in very preterm infants or other mammals within 10 days of birth. Our pre-specified primary outcomes were all-cause mortality and any harm, and, for the clinical studies, incidence of chronic lung disease. Included studies underwent risk of bias-assessment and data extraction performed by two authors independently. There were no language restrictions. Results Fifteen studies totally met our inclusion criteria: one randomized trial and four non-randomized studies in humans and 10 animal studies (five in rodents, two in lambs and one in either guinea pigs, rabbits or caprinae). All five clinical studies used montelukast and had a small sample size, ranging from 4 to 77 infants. The randomized trial (n = 60) found no difference in the incidence of chronic lung disease between the groups. Only one clinical study, which enrolled four very preterm infants and had a critical overall risk of bias, reported long-term outcomes. All other studies had unclear or greater overall risk of bias and meta-analyses were therefore deemed unfeasible. Eight of ten animal studies used leukotriene receptor antagonists as antileukotriene (montelukast in three of ten studies) and seven had an experimental study design (i.e. some animals were not exposed to antileukotrienes but no randomization). Three of the ten animal studies assessed different doses. Animal studies found no effect on the outcomes mortality, growth, or lung function related surrogate outcomes. Conclusions Use of antileukotrienes in very preterm infants to prevent or treat chronic lung disease is not supported by the available evidence. Large randomized trials focusing on outcomes relevant to patients, including long-term outcomes, are needed. Studies should also minimize risk of bias. |
| first_indexed | 2024-12-17T01:24:44Z |
| format | Article |
| id | doaj.art-52fcf1d97f3842fb86f04c5ba93f223c |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-17T01:24:44Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-52fcf1d97f3842fb86f04c5ba93f223c2022-12-21T22:08:43ZengBMCRespiratory Research1465-993X2021-07-0122112610.1186/s12931-021-01800-1Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic reviewMarlide Jukema0Franciszek Borys1Greta Sibrecht2Karsten Juhl Jørgensen3Matteo Bruschettini4Amsterdam UMC, Vrije Universiteit AmsterdamPoznan University of Medical SciencesDepartment of Newborns Infectious Diseases, Poznan University of Medical SciencesThe Nordic Cochrane Centre, Rigshospitalet Dept.Cochrane Sweden, Dept. Research and Development, Skåne University Hospital, Clinical Science Lund, Lund UniversityAbstract Background Very preterm infants are at high risk of developing chronic lung disease, which requires respiratory support and might have long-term sequelae. As lung inflammation plays an important role in pathogenesis, antileukotrienes have been explored in both clinical and animal studies. We aimed to assess the benefits and harms of antileukotrienes for the prevention and treatment of respiratory morbidity and mortality in very preterm newborns. Methods In this systematic review, we included randomized trials and non-randomized studies in humans and animals reporting the effects of antileukotrienes in very preterm infants or other mammals within 10 days of birth. Our pre-specified primary outcomes were all-cause mortality and any harm, and, for the clinical studies, incidence of chronic lung disease. Included studies underwent risk of bias-assessment and data extraction performed by two authors independently. There were no language restrictions. Results Fifteen studies totally met our inclusion criteria: one randomized trial and four non-randomized studies in humans and 10 animal studies (five in rodents, two in lambs and one in either guinea pigs, rabbits or caprinae). All five clinical studies used montelukast and had a small sample size, ranging from 4 to 77 infants. The randomized trial (n = 60) found no difference in the incidence of chronic lung disease between the groups. Only one clinical study, which enrolled four very preterm infants and had a critical overall risk of bias, reported long-term outcomes. All other studies had unclear or greater overall risk of bias and meta-analyses were therefore deemed unfeasible. Eight of ten animal studies used leukotriene receptor antagonists as antileukotriene (montelukast in three of ten studies) and seven had an experimental study design (i.e. some animals were not exposed to antileukotrienes but no randomization). Three of the ten animal studies assessed different doses. Animal studies found no effect on the outcomes mortality, growth, or lung function related surrogate outcomes. Conclusions Use of antileukotrienes in very preterm infants to prevent or treat chronic lung disease is not supported by the available evidence. Large randomized trials focusing on outcomes relevant to patients, including long-term outcomes, are needed. Studies should also minimize risk of bias.https://doi.org/10.1186/s12931-021-01800-1Preterm infantsChronic lung diseaseAnimal modelRespiratory morbiditySYRCLE |
| spellingShingle | Marlide Jukema Franciszek Borys Greta Sibrecht Karsten Juhl Jørgensen Matteo Bruschettini Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review Respiratory Research Preterm infants Chronic lung disease Animal model Respiratory morbidity SYRCLE |
| title | Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review |
| title_full | Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review |
| title_fullStr | Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review |
| title_full_unstemmed | Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review |
| title_short | Antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns: a systematic review |
| title_sort | antileukotrienes for the prevention and treatment of chronic lung disease in very preterm newborns a systematic review |
| topic | Preterm infants Chronic lung disease Animal model Respiratory morbidity SYRCLE |
| url | https://doi.org/10.1186/s12931-021-01800-1 |
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