Comparison of safety, effectiveness and cost-effectiveness of Combination of Levocetirizine and Fexofenadine with Montelukast in Allergic Rhinitis and its effect on quality of life

  • Suchita . Intern, Government Medical College and Rajindra Hospital, Patiala, Punjab
  • Dinesh Kumar Sharma Assistant Professor, Department of Otorhinolaryngology, Government Medical College and Rajindra Hospital, Patiala, Punjab
  • Gurjot Kaur Intern, Government Medical College and Rajindra Hospital, Patiala, Punjab
  • Arshdeep Singh Intern, Government Medical College and Rajindra Hospital, Patiala, Punjab
  • Sajeev Bhagat Professor and Head, Department of Otorhinolaryngology, Government Medical College and Rajindra Hospital, Patiala, Punjab
  • Prithpal Singh Matreja Professor, Department of Pharmacology, Teerthankar Mahavir Medical College and Research Centre, Teerthankar Mahavir University, Delhi Road, Moradabad, Uttar Pradesh, India-244001
Keywords: allergic rhinitis, fexofenadine, levocetirizine, safety, effectiveness.

Abstract

Background: Allergic Rhinitis (AR) manifest with rhinorrhea, nasal congestion, obstruction, and pruritus. The management of allergic rhinitis consists of: environmental control measures and allergen avoidance, pharmacological management, and immunotherapy. Combination of levocetirizine and fexofenadine with montelukast have shown a significant improvement in patients with allergic rhinitis, so we designed this study to assess the comparison of effectiveness and safety of montelukast-levocetirizine and montelukast-fexofenadine in allergic rhinitis.

Methodology:  This open-label, randomized, prospective, and parallel group study  was conducted at a teritary care hospital in a period of two months. All patient clinically diagnosed with allergic rhinitis in the age group of 18 to 60 years were included in the study. The patients were divided into two groups by random number table and patients in Group A received a combination of levocetrizine and monetluekast whereas patients n Group B received a combination of fexofenadine with monteluekast once daily for 20 days. The patients were called for two follow-ups first after 10 days of onset of therapy and second visit after 20 dyas of treatment and the patients were assessed clinically.

Results: The baseline characteristic of patients in both groups were comparable at baseline. There was a statistically significant decrease in total nasal symptom scores and total ophthalmic symptom score in both groups at 10 day and 20 days, though there was no statistically significant difference in both groups. There was a statistically significant decrease in quality of life scores in both groups at 10 days and 20 days, though at 20 day patients on levocetirizine had better response. There was a statistically significant higher cost of therapy in Group B.

Conclusion: Both Levocetirizine and Fexofenadine in combination with Monteleukast showed significant improvement as compared to baseline in terms of TNSS and TOSS. Patients in Levocetirizine group had a comparatively better quality of life, lesser side effects and low cost of therapy.

 

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Author Biographies

Dinesh Kumar Sharma, Assistant Professor, Department of Otorhinolaryngology, Government Medical College and Rajindra Hospital, Patiala, Punjab

 

 

Gurjot Kaur, Intern, Government Medical College and Rajindra Hospital, Patiala, Punjab

 

 

Arshdeep Singh, Intern, Government Medical College and Rajindra Hospital, Patiala, Punjab

 

 

Sajeev Bhagat, Professor and Head, Department of Otorhinolaryngology, Government Medical College and Rajindra Hospital, Patiala, Punjab

 

 

Prithpal Singh Matreja, Professor, Department of Pharmacology, Teerthankar Mahavir Medical College and Research Centre, Teerthankar Mahavir University, Delhi Road, Moradabad, Uttar Pradesh, India-244001

 

 

References

1. Immunotherapy for environmental allergies. Available at url: https://web.archive.org/web/20150617190743/http://www.niaid.nih.gov/topics/environmental-allergies/Pages/immunotherapy.aspx (Last Accessed 22nd April, 2020)
2. Skoner DP. Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 2001;108:S2-8.
3. Prasad R, Kumar R. Allergy situation in India: What is being done? Indian J Chest Dis Allied Sci. 2013;55:7-8.
4. Sur DK, Scandale S. Treatment of Allergic Rhinitis. Am Fam Physician 2010;81(12):1440-6.
5. Gupta V, Matreja PS. Efficacy of montelukast and levocetirizine as treatment for allergic rhinitis. J Allergy Ther 2010;1:103.
6. World allergic association (WAO) white book on allergy. Eds Pawankar R, Canonica GW, Holgate ST, Lockey RF. Available at url: https://www.worldallergy.org/UserFiles/file/WAO-White-Book-on-Allergy_web.pdf (Last Accessed on 22nd April, 2020)
7. Sheikh J. Allergic rhinitis treatment and management. Available at url: https://emedicine.medscape.com/article/134825-treatment#d9 (Last Accessed 22nd April, 2020)
8. Nettis E, Calogiuri GF, Di Leo E, Cardinale F, Macchia L, Ferrannini A, et.al. Once daily levocetirizine for the treatment of allergic rhinitis and chronic idiopathic urticaria. J Asthma Allergy 2009;2:17-23.
9. Meeves SG, Appajosyula S. Efficacy and safety profile of fexofenadine HCl: A unique therapeutic option in H1-receptor antagonist treatment. J Allergy Clin Immunol 2003;112(4):S69-77.
10. Draft Guidance for Industry on Allergic Rhinitis: Clinical Development Programs for Drug Products. US Dept. of Health and Human Services, Food and Drug Administration; April 2000.
11. Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy1991; 21: 77-83.
12. Pentewar GS, Wagh RJ, Chincholkar AS. Pharmacoeconomic assessment and comparing efficacy between cetirizine, levocetirizine, loratadine and fexofenadine in allergic rhinitis patients. Int J Basic Clin Pharmacol 2017;6:2684-9.
13. Shah A, Pawankar R. Allergic rhinitis and co-morbid asthma: perspective from India-ARIA Asia-Pacific Workshop report. Asian Pacific journal of allergy and immunology. 2009 Mar 1;27(1):71.
14. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA). Allergy. 2008 Apr 1;63(s86):8-160.
15. Bauchau V, Durham SR. Epidemiological characterization of the intermittent and persistent types of allergic rhinitis. Allergy. 2005 Mar 1;60(3):350-3.
16. Scarupa MD, Michael A. Kaliner Inflammatory Nature of Allergic Rhinitis: Pathophysiology. Medscape Allergy & Immunology. 2006;6(1).
17. Snidvongs K, Rotjanasiriphong S, Phannaso C, Chusakal S, Auemjaturapat S. Fexofenadine and levocetirizine have equivalent effectiveness for persistent allergic rhinitis. Asian Biomedicine 2015;9(3):387-95.
18. Nayak P, Srinivas CV, Jagade MV, Chandrasekharan S. A randomized, open label, prospective, comparative, multicentric study to evaluate the efficacy and safety of montelukast and fexofenadine fixed-dose combination vs. montelukast and levocetirizine fixed-dose combination in allergic rhinitis. Indian Journal of Clinical Practice 2013;24(3):241-6.
Published
2020-06-29
How to Cite
1.
. S, Sharma DK, Kaur G, Singh A, Bhagat S, Matreja PS. Comparison of safety, effectiveness and cost-effectiveness of Combination of Levocetirizine and Fexofenadine with Montelukast in Allergic Rhinitis and its effect on quality of life. Int Arch BioMed Clin Res [Internet]. 2020Jun.29 [cited 2020Sep.26];6(2):PH5-PH8. Available from: http://iabcr.org/index.php/iabcr/article/view/592
Section
ORIGINAL ARTICLES ~ Pharmacology