SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
10/19/04
Efficacy of budesonide/formoterol vs. higher dose budesonide in asthma
Summary
Background - Previous studies have shown that Advair, a combination of inhaled fluticasone, an inhaled corticosteroid (ICS) and salmeterol, a long acting beta agonist (LABA), is often more effective in controlling asthma than is double the dose of fluticasone used as monotherapy. More recently, Symbicort, a combination of budesonide (Bud), another ICS and formoterol, another LABA, is available in several countries. Do the same findings occur when Symbicort treatment is compared with twice the dose of Bud as monotherapy?
Findings - Scicchitano et al of the Royal Adelaide Hospital in Australia carried out a randomized double blind parallel group comparison of 1,890 adults with moderate/severe asthma of either a) Group 1 - Bud 320 mcg b.i.d. or b) Group 2-two puffs from a combination inhaler containing 160 mcg Bud/4.5 mcg formoterol per puff, (Form) used daily. After a 12 month study period, the risk of having an acute severe asthma exacerbation was 39% lower in the Group 2 patients, with 45% few exacerbations in these Group 2 patients (p<0.001). The patients in Group 2 used significantly less rescue beta agonist inhalation (p<0.001) and used oral steroids on fewer days. Indeed, the patients in Group 2 achieved sufficient asthma control to not require rescue medications on 60% of the days. Both treatments were well tolerated.
Reference
Curr Med Res Opin 2004;20:1403-18
Editor's Comments
These findings strongly suggest that a combination inhaler containing Bud and Form generally gives better asthma control than does twice as much as Bud used as monotherapy. In this regard, Bud/Form combination acts similar to the fluticasone/salmeterol combination studied earlier. The Bud/Form combination may have a potential advantage over the fluticasone/salmeterol combination in that the broncho-dilating effect of Form starts within a few minutes after inhalation, significantly earlier than the onset of salmeterol- induced bronchodilation.
|