Effect of Montelukast vs Placebo on Time to Sustained Recovery in Outpatients with COVID-19: The ACTIV-6 Randomized Clinical Trial
Authors: Rothman Russell L. , Stewart Thomas G. , Mourad Ahmad , Boulware David R. , McCarthy Matthew W. , Thicklin Florence , Garcia del Sol Idania T. , Garcia Jose Luis , Bramante Carolyn T. , Shah Nirav S. , Singh Upinder , Williamson John C. , Rebolledo Paulina A. , Jagannathan Prasanna , Schwasinger-Schmidt Tiffany , Ginde Adit A. , Castro Mario , Jayaweera Dushyantha , Sulkowski Mark , Gentile Nina , McTigue Kathleen , Felker G. Michael , DeLong Allison , Wilder Rhonda , Collins Sean , Dunsmore Sarah E. , Adam Stacey J. , Hanna George J. , Shenkman Elizabeth , Hernandez Adrian F. , Naggie Susanna , Lindsell Christopher J. ,   Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-6 Study Group and Investigators
Published: May 2024

Importance

The effect of montelukast in reducing symptom duration among outpatients with mild to moderate coronavirus disease 2019 (COVID-19) is uncertain.

Objective

To assess the effectiveness of montelukast compared with placebo in treating outpatients with mild to moderate COVID-19.

Design, Setting, and Participants

The ACTIV-6 platform randomized clinical trial aims to evaluate the effectiveness of repurposed medications in treating mild to moderate COVID-19. Between January 27, 2023, and June 23, 2023, 1250 participants ≥30 years of age with confirmed SARS-CoV-2 infection and ≥2 acute COVID-19 symptoms for ≤7 days, were included across 104 US sites to evaluate the use of montelukast.

Interventions

Participants were randomized to receive montelukast 10 mg once daily or matched placebo for 14 days.

Main Outcomes and Measures

The primary outcome was time to sustained recovery (defined as at least 3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of hospitalization, urgent care visit, emergency department visit, or death; COVID clinical progression scale; and difference in mean time unwell.

Results

Among participants who were randomized and received study drug, the median age was 53 years (IQR 42–62), 60.2% were female, 64.6% identified as Hispanic/Latino, and 56.3% reported ≥2 doses of a SARS-CoV-2 vaccine. Among 628 participants who received montelukast and 622 who received placebo, differences in time to sustained recovery were not observed (adjusted hazard ratio [HR] 1.02; 95% credible interval [CrI] 0.92–1.12; P(efficacy) = 0.63]). Unadjusted median time to sustained recovery was 10 days (95% confidence interval 10–11) in both groups. No deaths were reported and 2 hospitalizations were reported in each group; 36 participants reported healthcare utilization events (a priori defined as death, hospitalization, emergency department/urgent care visit); 18 in the montelukast group compared with 18 in the placebo group (HR 1.01; 95% CrI 0.45–1.84; P(efficacy)=0.48). Five participants experienced serious adverse events (3 with montelukast and 2 with placebo).

Conclusions and Relevance

Among outpatients with mild to moderate COVID-19, treatment with montelukast does not reduce duration of COVID-19 symptoms.

Trial Registration

ClinicalTrials.gov(NCT04885530).