# Leukotriene receptor antagonists and eosinophilic granulomatosis with polyangiitis: a disproportionality analysis from FAERS, JADER, CVAR databases integrated with network pharmacology

## TL;DR

This study finds that leukotriene receptor antagonists may increase the risk of a rare autoimmune disease called EGPA and identifies potential genetic mechanisms behind this association.

## Contribution

The study is the first to integrate pharmacovigilance data with network pharmacology to explore the risk and mechanisms of LTRAs-induced EGPA.

## Key findings

- LTRAs like montelukast are strongly associated with EGPA across multiple databases.
- Montelukast remains significantly linked to EGPA even when corticosteroids are excluded.
- Key genes such as SRC, PTGS2, and EDN1 are identified as central to LTRAs-induced EGPA.

## Abstract

The relationship between leukotriene receptor antagonists (LTRAs) usage and the subsequent occurrence of eosinophilic granulomatosis with polyangiitis (EGPA) remained highly polarizing and controversial in previous studies. We aimed to investigate the risk of EGPA caused by LTRAs and the potential toxicological mechanisms of LTRAs-related EGPA.

In this real-world pharmacovigilance study, we collected adverse event (AE) reports of EGPA associated with LTRAs use from the U.S. FDA Adverse Event Reporting System (FAERS), Japanese Adverse Drug Event Reporting (JADER), and Canadian Vigilance Adverse Reaction (CVAR) databases. The reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and empirical Bayesian geometric mean (EBGM) were calculated to quantify the strength of the association between LTRAs and EGPA. The Weibull shape parameter (WSP) test was applied to analyze time-to-onset profiles of EGPA toxicity. Network pharmacology analysis was subsequently performed to identify the central genes to determine the potential mechanisms underlying LTRAs-induced EGPA.

LTRAs, including montelukast, zafirlukast, and pranlukast, exhibited a strong association with EGPA in three databases (the lower limit of 95% confidence interval (CI) for ROR > 1, PRR > 2 with χ2 values ≥4, EBGM05 > 2, and IC025 > 0). After excluding corticosteroids as concomitant medication, montelukast remained significantly associated with EGPA in the FAERS database. The median time-to-onset of EGPA associated with LTRAs was 233 (range: 76–660) days, and the WSP test indicated LTRAs had early failure-type profiles. We isolated 81 interactive target genes linking LTRAs to EGPA. Several central genes, including SRC, PTGS2, EDN1, HMOX1, KDR, and OCLN, were revealed via protein-protein interactions analysis and molecular complex detection (MCODE) algorithm.

Our study revealed LTRAs could increase the risk of EGPA, and initially explored potential genes and mechanisms of LTRAs-induced EGPA. It is helpful for clinicians to be alerted to the risk of EGPA during LTRAs administration.