Abstract
This 12-week study compared the efficacy and safety of a fixed combination of fluticasone propionate plus formoterol (FL/F) 250/12 μgb.i.d. administered via a dry powder inhaler (DPI) to a combination of budesonide plus formoterol (BD/F) 400/12 μgb.i.d. After a 2-week run-in period (in which all patients were treated exclusively with budesonide plus formoterol), patients aged 12–65 years of age (N = 98) with uncontrolled asthma were randomized into an actively controlled, open-labelled, parallel-group study. The primary objective was to demonstrate non-inferiority, measured by morning peak expiratory flow (mPEF).
The non-inferiority was demonstrated. A statistically significant improvement from baseline was observed in both groups in terms of lung function, asthma control, and the use of rescue medication. FL/F demonstrated a statistical superiority to BD/F in terms of lung function (FEV1) (p = 0.01) and for asthma control (p = 0.02). Non-significant between-group differences were observed with regards to exacerbation rates and adverse events.
In uncontrolled or partly controlled asthma patients, the use of a combination of fluticasone propionate plus formoterol via DPI for 12-weeks was non-inferior and showed improvements in FEV1 and asthma control when compared to a combination of budesonide plus formoterol.
Keywords: Asthma control questionnaire; Forced expiratory volume in 1s; Single inhaler; Non-inferiority; Morning peak expiratory flow.
References
- Global Initiative for Asthma. Date last updated. Date last accessed: January 2013. Available from:, http://www. ginasthma.com; December 2012.
- Murphy KR, Bender Treatment of moderate to severe asthma: patient perspectives on combination inhaler therapy and implications for adherence. J Asthma Allergy 2009;2: 63e72.
- Howell G. Nonadherence to medical therapy in asthma: risk factors, barriers, and strategies for improving. J Asthma 2008; 45:723e9.
- Jaffuel D, Demoly P, Gougat C, Balaguer P, Mautino G, Godard P, et al. Transcriptional potencies of inhaledgluco- corticoids. Am J RespirCrit Care Med 2000;162:57e63.
- Esmailpour N, Ho¨gger P, Rabe KF, Heitmann U, Nakashima M, Rohdewald P. Distribution of inhaled fluticasone propionate between human lung tissue and serum in vivo. Eur Respir J 1997;10: 1496e9.
- [Luijk B, Kempsford RD, Wright AM, Zanen P, Lammers Duration of effect of single-dose inhaled fluticasone propio- nate on AMP-induced bronchocons-triction. EurRespir J 2004; 23:559e64.
- Adams NP, Bestall JC, Lasserson TJ, Jones P, Cates Fluti- casoneversus placebo for chronic asthma in adults and chil- dren. Cochrane Database Syst Rev 2008. CD003135.
- Palmqvist M, Persson G, Lazer L, Rosenborg J, Larsson P, Lo¨tvall J. Inhaled dry-powder formoterol and salmeterol in asthmatic patients: onset of action, duration of effect and potency. EurRespir J 1997;10:2484e9.
- O’Byrne PM, Bisgaard H, Godard PP, Pistolesi M, Palmqvist M, Zhu Y, et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J RespirCrit Care Med 2005;171:129e36.
- Bodzenta-Lukaszyk A, Pulka G, Dymek A, Bumbacea D, McIver T, Schwab B, et al. Efficacy and safety of fluticasone and formoterol in a single pressurized metered dose Respir Med 2011;105:674e82.
- Bodzenta-Lukaszyk A, Dymek A, McAulay K, Mansikka H. Flu- ticasone/formoterol combination therapy is as effective as fluticasone/salmeterol in the treatment of asthma, but has a more rapid onset of action: an open-label, randomized study. BMC Pulm Med 2011;11:28.
- Bodzenta-Lukaszyk A, Buhl R, Balint B, Lomax M, Spooner K, Dissanayake S. Fluticasone/formoterol combination therapy versus budesonide/formoterol for the treatment of asthma: a randomized, controlled, non-inferiority trial of efficacy and safety. J Asthma 2012;49:1060e70.
- Nathan RA, D’Urzo A, Blazhko V, Kaiser K. Safety and efficacy of fluticasone/ formoterol combination therapy in adolescent and adult patients with mild-to-moderate asthma: a rando- mised controlled trial. BMC Pulm Med 2012;12:67.
- Dissanayake S, Grothe B, Kaiser K. Fluticasone/formoterol: a new single-aerosol combination therapy for patients with asthma. Respir Med 2012;106(Suppl.):S20e8.
- Corren J, Mansfield LE, Pertseva T, Blahzko V, Kaiser K. Efficacy and safety of fluticasone/formoterol combination ther- apy in patients with moderate-to-severe asthma. Respir Med 2013;107:180e95.
- McKeage K. Fluticasone propionate/ formoterol fumarate: a review of its use in persistent Drugs 2013;73: 195e206.
- Bodzenta-Lukaszyk A, Van Noord J, Schro¨der-Babo W, McAulay K, McIver T. Efficacy and safety profile of fluticaso- ne/formoterol combination therapy compared to its individual components administered concurrently in asthma: a rando- mised controlled trial. Curr Med Res Opin 2013;29:579e88.
- Neffen H, Fritscher C, Schacht FC, Levy G, Chiarella P, Soriano JB, et al. Asthma control in Latin America: the asthma insights and reality in Latin America (AIRLA) survey. Rev Panam Salud Publica 2005;17:191e7.
- Ponte EV, Petroni J, Ramos DCB, Pimentel L, Freitas DN, Cruz Perception of asthma control in asthma patients. J Bras Pneumol 2007;33:635e40.
- FitzGerald JM, Boulet L-P, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J 2006; 13:253e9.
- Gamble J, Stevenson M, Heaney LG. A study of a multi-level intervention to improve non-adherence in difficult to control asthma. Respir Med 2011;105: 1308e15.
- Horne R. Compliance, adherence, and concordance: implications for asthma treatment. Chest 2006;130:65Se72S.
- Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King Development and validation of a questionnaire to measure asthma control. EurRespir J 1999;14:902e7.
- Leite M, Ponte EV, Petroni J, D’Oliveira Ju´nior A, Pizzichini E, Cruz Evaluation of the asthma control questionnaire validated for use in Brazil. J Bras Pneumol 2008;34:756e63.
- Pereira CAC, Jansen JM, MennaBarreto SS, Martinho J, Sulmonett NDR. Espirometria. J Pneumol 2002;28:1e82.
- Pereira CA de C, Sato T, Rodrigues New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol 2007;33:397e406.
- Ladosky W, Andrade RT, Loureiro NG, Botelho Com- para¸ca˜o entre osvaloresteo´ricos para alguns dadosespir- ome´tricosemcrian¸casdeterminadospelasequa¸c˜oes de Mallozi e de Polgar. J Pneumol 2002;28:125e30.
- Esmailpour N, Ho¨gger P, Rohdewald P. Binding kinetics of budesonide to the human glucocorticoid receptor. Eur J Pharm Sci 1998;6:219e23.
- Barnes NC, Hallett C, Harris Clinical experience with fluticasone propionate in asthma: a meta-analysis of efficacy and systemic activity compared with budesonide and beclomethason-edipropionate at half the microgram dose or less. Respir Med 1998;92:95e104.
- Voshaar T, Kostev K, Rex J, Schro¨der-Bernhardi D, Maus J, Munzel A retrospective database analysis on persistence with inhaled corticosteroid therapy: comparison of two dry powder inhalers during asthma treatment in Germany. IntJClinPharmacolTher 2012; 50:257e64.
- O’Byrne PM. Clinical comparisons of inhaler systems: what arethe important aspects? J Aerosol Med 1995;8(Suppl. 3):S39e46 [discussion S47].
- Pereira LFF, Toufen Jr C. Impact that display an educational film, changes in powder inhaler device and in the instructions given to the patient have on the inhaler handling RBM 2011;68:22e7.
- Santanello NC, Zhang J, Seidenberg B, Reiss TF, Barber What are minimal important changes for asthma measures in a clinical trial? EurRespir J 1999;14:23e7.
- Reddel HK, Taylor DR, Bateman ED, Boulet L-P, Boushey HA, Busse WW, et al. An official American Thoracic Society/ Eur- opean Respiratory Society statement: asthma control and exacerba-tions: standardizing endpoints for clinical asthma trials and clinical Am J Respir Crit Care Med 2009; 180:59e99.
- Gluud Bias in clinical intervention research. Am J Epi- demiol 2006;163: 493e501.
- Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder in- halers on management of patients with asthma and COPD. Respir Med 2008;102: 593e604.
Corresponding Author
Dr Sanjay Kumar Jangid
Associate Professor, Department of General Medicine, Hi-tech Medical College and Hospital Bhubaneswar-751025 Odisha, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: 9337671521