Effect of anti-leukotrienes versus corticosteroids in prevention of recurrence of nasal polyps

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is among the most challenging types of chronic rhinosinusitis to manage and shows common recurrence irrespective of therapeutic modality. Aim: To evaluate the influence of montelukast (a leukotriene receptor antagonist) on preventing recurrence of nasal polyps, and to compare it with corticosteroids (systemic and intranasal). Patients and methods: This prospective randomized research was carried out at the Al-Azhar University Hospitals (Al-Hussein &Sayed Galal ). This study included 60 cases who were suffering from Chronic rhinosinusitis with nasal polyposis CRSwNP, either primary or recurrent nasal polyps, classified into 2 groups, Group A (n=30): Received prednisolone thirty milligram daily for 14 days, then tapered by five milligram every second day for 1 week; budesonide nasal spray (metered doses) twice daily per nostril for 6 months; montelukast ten milligram daily for 6 months. Group B (n=30): Received prednisolone thirty milligrams daily for 14 days, then tapered by five milligrams every second day for 1 week; budesonide nasal spray (metered doses) twice daily per nostril for 6 months. Results: Both groups showed significant reductions in Lund-Mackay and SNOT-22 scores (p<0.001), with no significant intergroup differences. Group A had significantly lower tissue LTC4 levels (p=0.028) and recurrence rates (6.7% vs. 26.7%, p=0.038) compared to Group B. Peripheral eosinophil counts showed no significant changes. Conclusion: Leukotriene Antagonists (LTAs) such as Montelukast might give further advantage to oral and Intranasal Corticosteroids (INCS) therapy in individuals with chronic nasal polyps and decrease the rate of recurrence.