Monday, August 23, 2010

More on Using Singulair Treatment for Capsular Contracture

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active.

Previously I reviewed the literature on the off-label use of zafirlukast (Accolate) and montelukast (Singulair) for the treatment of capsular contracture.  The recent issue (May/June 2010) of the Aesthetic Surgery Journal has an article (full reference below) on the use of Singulair for capsular contracture (CC).
Huang and Handel’s article reviews the literature, noting some articles I missed.  Their study is a small (17 patients, 4 with bilateral CC for a total of 21breasts treated with Baker’s Grade II or greater CC).  All of their patients were informed of possible risks associated with the off-label application of Singulair before being prescribed 10 mg of Singulair for 90 days and instructed to massage their breasts twice daily.
Unlike Accolate, the adverse event profile of Singulair is comparable to placebo, with the most common side effects being headache (18.4% vs 18.1%), influenza-like symptoms (4.2% vs 3.9%), abdominal pain (2.9% vs 2.5%), cough (2.7% vs 2.4%), and dyspepsia (2.1% vs 1.1%).
Follow-up of patient compliance and treatment results was obtained by a combination of chart review and a standardized telephone questionnaire.  Telephone interviews were used to determine the actual duration and dose of Singulair taken by the patient and whether the patient noted improvement, no change, or worsening of contracture.
The authors note that this is only a preliminary study show without a well-matched population of negative controls.  That said:
Our follow-up data showed that in two (11%) patients, the CC worsened, three (16%) patients had no change, five (26%) improved, and seven (37%) completely resolved.
As for adverse effects from Singulair:
Only one of our patients reported any side effect (fatigue). All other patients tolerated the treatment without any problems.
Their conclusions are (bold highlight is mine):
Our article presents preliminary findings on the off-label use of Singulair for CC. The drug is well tolerated with minimal side effects; therefore, we recommend its application in patients with CC. There was a greater response in breasts with mild CC, so a course of Singulair should be started early. Because it prevented recurrence in two patients with previous severe contracture, we recommend prophylactic prescription in patients with a history of recurrent contracture. In patients who already have moderately advanced CC, Singulair is unlikely to reverse symptoms to the degree that revision can be avoided.
This is a topic I will continue to follow with interest.

Catherine K. Huang, Neal Handel; Effects of Singulair (Montelukast) Treatment for Capsular Contracture; Aesthetic Surgery Journal May/June 2010 30: 404-408; doi:10.1177/1090820X10374724

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