Desloratadine 5mg tablets

Allergic rhinitis (AR) significantly impairs quality of life and often necessitates combination therapies for optimal symptom control. This study aimed to evaluate the efficacy of montelukast-antihistamine combination therapy in patients with AR by using a network meta-analysis. A comprehensive search was conducted using PubMed, Embase, MEDLINE, Scopus, the Cochrane Library, and Google Scholar up to April 2025. The treatment strategies included montelukast alone, antihistamine monotherapies (loratadine, desloratadine, levocetirizine, and fexofenadine), their respective combinations with montelukast, including bilastine. Outcomes included daytime and nighttime symptom scores, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and individual symptoms. Both pairwise and network meta-analyses were conducted. Thirty studies (4,486 patients) were included. Montelukast combinations with desloratadine (standardized mean difference [SMD] = -0.51), levocetirizine (SMD = -0.44), and loratadine (SMD = -0.31) significantly improved daytime nasal symptoms compared to montelukast alone. Only montelukast-levocetirizine improved nighttime symptoms (SMD = -0.21) and RQLQ (SMD = -0.48). The combinations with desloratadine or levocetirizine were superior for nasal obstruction, sneezing, and itching, while nasal discharge improved only with montelukast-levocetirizine. No treatment significantly improved eye symptoms. Surface under the cumulative ranking curve rankings generally favored combination therapies, though trends varied by outcome. Desloratadine monotherapy ranked highest for nasal itching. Although some comparisons require cautious interpretation, montelukast-based combination therapy demonstrated greater efficacy than monotherapy for multiple AR symptoms. These results highlight the importance of selecting therapeutic strategies based on the predominant symptom profile of individual patients.

Abstract licence: CC BY-NC

BackgroundAllergic rhinitis (AR) is an atopic condition affecting over 400 million people worldwide, impairing quality of life and often leading to complications such as asthma and sinusitis. Montelukast, a leukotriene receptor antagonist, is often used in combination with second-generation antihistamines (sgAHs) to enhance symptom control. However, the relative efficacy of different montelukast-sgAH combinations remains unclear.ObjectiveTo evaluate and compare the efficacy of montelukast combined with various sgAHs versus montelukast monotherapy in patients with AR.MethodsRandomized controlled trials (RCTs) comparing montelukast-sgAH combinations to montelukast alone were identified from 5 electronic databases up to 2025. Outcomes included Total Nasal Symptom Score (TNSS; 0-12), Daytime and Nighttime Nasal Symptom Scores (DNSS, NNSS; 0-3), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ; 0-6). Risk of bias (RoB) was assessed using Cochrane RoB 2.0. A frequentist network meta-analysis with subgroup analysis and meta-regression was performed using RStudio and Jeffreys's Amazing Statistics Program.ResultsSeventeen RCTs involving 2,655 participants were included. For TNSS improvement, montelukast + desloratadine combination is significantly better than monotherapy in adults (mean difference [MD] = -0.92 [-1.15 to -0.69]) and children (MD = -1.95 [-3.46 to -0.44]). Effects on RQLQ and DNSS were inconsistent, while NNSS improved with montelukast-levocetirizine (P = 0.0384). Heterogeneity was high, but most studies showed low risk of bias. No serious adverse events were reported.ConclusionMontelukast-sgAH combinations may improve symptoms over monotherapy, especially with desloratadine in both adults and children. However, variability across outcomes and high heterogeneity warrant cautious interpretation and further research.

Abstract licence: CC BY