Effects of low-versus high-dose fluticasone propionate/formoterol fumarate combination therapy on AMP challenge in asthmatic patients: A double-blind, randomised clinical trial.

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Abstract

BACKGROUND:

The dose-response relationship between two dose levels of fluticasone/formoterol (flutiform®, 100/10 μg and 500/20 μg) was evaluated in asthmatic patients. Non-invasive inflammatory markers were used including adenosine monophosphate (AMP) challenge (primary endpoint), and sputum eosinophils and fractional exhaled nitric oxide (FeNO) (secondary endpoints).
METHODS:

Patients aged ≥18 years with forced expiratory volume in 1 second (FEV1) ≥60% predicted and who required a dose of <60 mg AMP to elicit a 20% drop in FEV1 (AMP PD20) were randomised in this incomplete block, crossover study to receive 2 of 3 treatments b.i.d.: fluticasone/formoterol 500/20 μg (high dose), 100/10 μg (low dose) or placebo, during 2 periods of 28±3 days each, separated by 2-3 weeks. AMP challenges were performed pre-dose and 12 hours after last dose at the end of each treatment period. A series of post hoc analyses were performed only in patients allocated to both fluticasone/formoterol doses, who completed the study and had evaluable AMP PD20 data for both treatments ("fluticasone/formoterol subgroup"). Changes in AMP PD20 FEV1, percentage sputum eosinophils and FeNO levels (day 1 vs day 28) between treatments were compared by an analysis of covariance (ANCOVA).
RESULTS:

Sixty-two patients were randomised and 46 completed the study. Fifteen patients received both high- and low-dose fluticasone/formoterol (post hoc subgroup). The difference in AMP PD20 for the overall population was not statistically significant between high- and low-dose fluticasone/formoterol (LS mean fold difference: 1.3; p=0.489), although both dose levels were superior to placebo: high-dose vs placebo LS mean fold difference: 4.4, p<0.001; low-dose vs placebo LS mean fold difference: 3.5, p<0.001. In the post hoc subgroup, the difference in AMP PD20 between the doses was statistically significant in favour of the high-dose (LS mean fold difference: 2.4, p=0.012). Other inflammatory parameters (sputum eosinophil counts and FeNO) showed small differences and statistically non-significant changes between high- and low-dose fluticasone/formoterol.
CONCLUSIONS:

A significant dose-response was found between low- and high-dose fluticasone/formoterol in the post hoc subgroup (patients who received both doses), but not in the overall population, with the higher dose demonstrating a greater reduction in airway responsiveness to AMP.

Detaljer

Författare
Enheter & grupper
Externa organisationer
  • University of Groningen
  • QPS-Netherlands
  • Mundipharma Research Ltd
  • Gemeinschaftspraxis Reinfeld
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Lungmedicin och allergi
Originalspråkengelska
Sidor (från-till)65-72
TidskriftPulmonary Pharmacology & Therapeutics
Volym37
Tidigt onlinedatum2016 feb 18
StatusPublished - 2016
PublikationskategoriForskning
Peer review utfördJa