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Researchers have been doing studies for many years regarding tryi...

Posted at 3: 2 PM on Feb 03, 2009 by concernedcitizen, #38627
Researchers have been doing studies for many years regarding trying to determine the role of genetic factors in patients response to Singulair (Montelukast). This study from Spain identified the following gene variations hypothesize to be related to leukotriene pathway response. Sixty one patients with asthma were studied. Three gene types were identified: type 1. Thirty-two patients (52.5%) were homozygous for the five repeats allele; type 2. 17 (27.9%) were heterozygous (4/5 repeats) type 3. 12 (19.7%) were homozygous for 4/4 repeats. The study showed that montelukast was effective for types 1 and 2 but not effective for type 3. Type 3 represented approximately 20% of the group study. "After the montelukast treatment decrease number of asthma exacerbations, improvement of FEV(1) and decreased use of beta(2) agonists was observed in patients with 5/5 or 4/5 repeats. Conversely, the patients with 4/4 repeats genotype did not modify these data after treatment." So it seems logical that if it can be identified that montelukast is not effective for certain gene type variations, then montelukast could cause adverse side effects in certain gene type variations. It is interesting that 20% of this group does not respond positively to montelukast. That is the exact same number that even Merck says gets a headache from montelukast. Headache is the highest incidence of adverse side effects that has been reported. That comparison, however, is just a coincidence because it has not been studied and proven. Maybe. Where are the studies that pertain to gene type variations and adverse side effects? You would think that somebody could do them. Respir Med. 2008 Jun;102(6):857-61. Epub 2008 Mar 12. Links ALOX5 promoter genotype and response to montelukast in moderate persistent asthma.Telleria JJ, Blanco-Quiros A, Varillas D, Armentia A, Fernandez-Carvajal I, Jesus Alonso M, Diez I. Institute of Biology and Molecular Genetics (IBGM/CSIC), University of Valladolid, Valladolid, Spain. ****** BACKGROUND: It was hypothesized that asthmatic patients with mutant alleles in the leukotriene pathway should not respond to leukotriene receptor antagonists and the concept of a tailored treatment is increasingly supported. METHODS: Sixty-one patients (mean age 24.9 years, range 14-52) with moderate persistent asthma were clinical and immunological assess prior and after a 6-month treatment with montelukast. Tandem repeat polymorphisms were genotyped in the promoter (-147 to -176) of 5-lipoxygenase gene (ALOX5). RESULTS: Thirty-two patients (52.5%) were homozygous for the five repeats allele; 17 (27.9%) were heterozygous (4/5 repeats) and 12 (19.7%) were homozygous for 4/4 repeats. After the montelukast treatment decrease number of asthma exacerbations, improvement of FEV(1) and decreased use of beta(2) agonists was observed in patients with 5/5 or 4/5 repeats. Conversely, the patients with 4/4 repeats genotype did not modify these data after treatment. CONCLUSIONS: It was confirmed that ALOX5 promoter polymorphisms have a clear influence in montelukast response in atopic moderate persistent asthma patients. The genetic study could identify those patients most likely to respond to montelukast. PMID: 18339529 [PubMed - indexed for MEDLINE]
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Reply about 1 year ago on Feb 03, 2009 by flindy, #16714

Singulair most reported side effects and reactions by year
Year Description Frequency
2004 ALLERGIC GRANULOMATOUS ANGIITIS 66
ABDOMINAL PAIN 7
ALANINE AMINOTRANSFERASE INCREASED 6
ASTHMA 6
CONVULSION 6
2005 ALLERGIC GRANULOMATOUS ANGIITIS 148
ASTHMA 18
ALANINE AMINOTRANSFERASE INCREASED 11
ABDOMINAL PAIN UPPER 10
ATRIAL FIBRILLATION 8
2006 ALLERGIC GRANULOMATOUS ANGIITIS 129
ASTHMA 28
CONVULSION 19
ABORTION SPONTANEOUS 14
ALANINE AMINOTRANSFERASE INCREASED 12
2007 ALLERGIC GRANULOMATOUS ANGIITIS 111
ASTHMA 29
CONVULSION 17
AGGRESSION 13
STEVENS-JOHNSON SYNDROME 11
2008 ABNORMAL BEHAVIOUR 232
DEPRESSION 147
ANXIETY 115
SUICIDAL IDEATION 90
AGGRESSION 81
These are reports to the FDA by year,isnt it possible all these side effects are some form of vasculitis,the number one reported side effect for years ??????

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Reply about 1 year ago on Feb 03, 2009 by concernedcitizen, #16725

flindy,

You comment was made through keen observation. I tend to agree with you that vasculitis is possibly connected to Singulair adverse side effects.

My opinion is that Singulair and nitric oxide is the key issue. Excessive production of nitric oxide due to adverse reaction to Singulair could cause vasculitis - meaning vasodilation/constriction and severe inflammation.

This is quoted from research on vasculitis.

"Cells of the vasculature play a central role in physiology and pathology. Endothelial cells control platelet adhesion, maintain a balance of fibrinolytic and prothrombotic activity, regulate vascular tone and play a critical role in regulating the recruitment of leucocytes into inflammatory sites Regulation of vascular tone is dependent on the production of vasodilators, such as nitric oxide (NO) and prostacyclin, and vasoconstrictors, such as endothelin. While cells of the vasculature (such as endothelial cells and platelets) have been proposed to be the major producers of vasoconstrictors and vasodilators, it is now becoming clear that stromal cells such as fibroblasts and smooth muscle cells can also produce biologically active proteins that act in a paracrine manner to regulate endothelial cell function."

I really don't think the FDA wants to know how Singulair works. They always just look at clinical data. As in every study or experiment, the answer you get depends upon what you are looking for. Until the FDA wants to research how Singulair works and why patients have adverse side effects, then we just observe and speculate.

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