1
|
Singh GJP, Hickey AJ. Pharmacokinetic Bioequivalence between Generic and Originator Orally Inhaled Drug Products: Validity of Administration of Doses above the Approved Single Maximum Dose. Mol Pharm 2024; 21:4191-4198. [PMID: 39133824 DOI: 10.1021/acs.molpharmaceut.4c00479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2024]
Abstract
Pharmacokinetic bioequivalence of orally inhaled drug products is a critical component of the US FDA's "weight of evidence" approach, and it can serve as the sole indicator of safety and effectiveness of follow-on inhalation products approved in Europe and some other geographic areas. The approved labels of the orally inhaled drug products recommend the maximum number of actuations that can be administered in a single dose on one occasion. This single maximum dose may consist of one or more inhalations depending upon the product. Bioequivalence studies for the inhalation drug product registrations in the US and EU have employed single and multiple actuation doses, in some cases over and above the approved single maximum labeled doses, thus, inconsistent with the approved labeling of the reference products. Pharmacokinetics of inhaled drug products after single and multiple doses may be different, with implications for bioequivalence determined at single and multiple doses. Scientific literature indicates that the relative bioavailability of the Test and Reference products may differ between administrations of doses in one and multiple inhalations. Multiple doses not only alter the pharmacokinetics but also may reduce the sensitivity of the bioassay to actual differences between the Test and Reference product performances. Ability of the pharmacokinetic bioassay to accurately determine the extent of difference between two products may also be substantially reduced at high doses. Therefore, in our opinion, pharmacokinetic bioequivalence to support regulatory approvals of inhalation products at doses above the recommended single maximum dose should be avoided. Furthermore, the bioequivalence of products (if any) established at doses exceeding the approved single maximum doses should be revisited to determine if the products maintain bioequivalence when evaluated at the clinically relevant single maximum doses.
Collapse
Affiliation(s)
- Gur Jai Pal Singh
- BBSG Pharm Associates, LLC, 7641 Summer Day Drive, Corona, California 92883, United States
| | - Anthony J Hickey
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 125 Mason Farm Road, Chapel Hill, North Carolina 27599, United States
| |
Collapse
|
2
|
Brattsand R, Selroos O. Budesonide Attains Its Wide Clinical Profile by Alternative Kinetics. Pharmaceuticals (Basel) 2024; 17:503. [PMID: 38675463 PMCID: PMC11055149 DOI: 10.3390/ph17040503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The introduction of inhaled corticosteroids (ICSs) changed over a few decades the treatment focus of mild-to-moderate asthma from bronchodilation to reduction in inflammation. This was achieved by inhaling a suitable corticosteroid (CS), giving a high, protracted airway concentration at a low total dose, thereby better combining efficacy and tolerance than oral therapy. Successful trials with the potent, lipophilic "skin" CS beclomethasone dipropionate (BDP) paved the way, suggesting that ICSs require a very low water solubility, prolonging their intraluminal dissolution within airways. The subsequent ICS development, with resulting clinical landmarks, is exemplified here with budesonide (BUD), showing that a similar efficacy/safety relationship is achievable by partly alternative mechanisms. BUD is much less lipophilic, giving it a 100-fold higher water solubility than BDP and later developed ICSs, leading to its more rapid intraluminal dissolution and faster airway and systemic uptake rates. In airway tissue, a BUD fraction is reversibly esterified to intracellular fatty acids, a lipophilic conjugate, which prolongs airway efficacy. Another mechanism is that the rapidly absorbed bulk fraction, via short plasma peaks, adds anti-inflammatory activity at the blood and bone marrow levels. Importantly, these plasma peaks are too short to provoke systemic adverse actions. Controlled clinical trials with BUD changed the use of ICS from a last resort to first-line treatment. Starting ICS treatment immediately after diagnosis ("early intervention") became a landmark for BUD. An established dose response made BUD suitable for the treatment of patients with all degrees of asthma severity. With the development of the budesonide/formoterol combination inhaler (BUD/FORM), BUD contributed to the widely used BUD/FORM maintenance and reliever therapy (MART). Recent studies demonstrated the value of BUD/FORM as a generally recommended as-needed therapy for asthma ("anti-inflammatory reliever", AIR). These abovementioned qualities have all influenced international asthma management and treatment guidelines.
Collapse
Affiliation(s)
| | - Olof Selroos
- Independent Researcher, 25266 Helsingborg, Sweden;
| |
Collapse
|
3
|
Zhang C, D'Angelo D, Buttini F, Yang M. Long-acting inhaled medicines: Present and future. Adv Drug Deliv Rev 2024; 204:115146. [PMID: 38040120 DOI: 10.1016/j.addr.2023.115146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Inhaled medicines continue to be an essential part of treatment for respiratory diseases such as asthma, chronic obstructive pulmonary disease, and cystic fibrosis. In addition, inhalation technology, which is an active area of research and innovation to deliver medications via the lung to the bloodstream, offers potential advantages such as rapid onset of action, enhanced bioavailability, and reduced side effects for local treatments. Certain inhaled macromolecules and particles can also end up in different organs via lymphatic transport from the respiratory epithelium. While the majority of research on inhaled medicines is focused on the delivery technology, particle engineering, combination therapies, innovations in inhaler devices, and digital health technologies, researchers are also exploring new pharmaceutical technologies and strategies to prolong the duration of action of inhaled drugs. This is because, in contrast to most inhaled medicines that exert a rapid onset and short duration of action, long-acting inhaled medicines (LAIM) improve not only the patient compliance by reducing the dosing frequency, but also the effectiveness and convenience of inhaled therapies to better manage patients' conditions. This paper reviews the advances in LAIM, the pharmaceutical technologies and strategies for developing LAIM, and emerging new inhaled modalities that possess a long-acting nature and potential in the treatment and prevention of various diseases. The challenges in the development of the future LAIM are also discussed where active research and innovations are taking place.
Collapse
Affiliation(s)
- Chengqian Zhang
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark
| | - Davide D'Angelo
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark; Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Francesca Buttini
- Food and Drug Department, University of Parma, Parco Area delle Scienze 27/A, 43124 Parma, Italy
| | - Mingshi Yang
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100 Copenhagen, Denmark; Wuya College of Innovation, Shenyang Pharmaceutical University, Wenhua Road No. 103, 110016, Shenyang, China.
| |
Collapse
|
4
|
Hastedt JE, Bäckman P, Cabal A, Clark A, Ehrhardt C, Forbes B, Hickey AJ, Hochhaus G, Jiang W, Kassinos S, Kuehl PJ, Prime D, Son YJ, Teague S, Tehler U, Wylie J. iBCS: 3. A Biopharmaceutics Classification System for Orally Inhaled Drug Products. Mol Pharm 2024; 21:164-172. [PMID: 38059771 PMCID: PMC10762654 DOI: 10.1021/acs.molpharmaceut.3c00685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/28/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
In this article, we specify for the first time a quantitative biopharmaceutics classification system for orally inhaled drugs. To date, orally inhaled drug product developers have lacked a biopharmaceutics classification system like the one developed to navigate the development of immediate release of oral medicines. Guideposts for respiratory drug discovery chemists and inhalation product formulators have been elusive and difficult to identify due to the complexity of pulmonary physiology, the intricacies of drug deposition and disposition in the lungs, and the influence of the inhalation delivery device used to deliver the drug as a respirable aerosol. The development of an inhalation biopharmaceutics classification system (iBCS) was an initiative supported by the Product Quality Research Institute (PQRI). The goal of the PQRI iBCS working group was to generate a qualitative biopharmaceutics classification system that can be utilized by inhalation scientists as a "rule of thumb" to identify desirable molecular properties and recognize and manage CMC product development risks based on physicochemical properties of the drug and the deposited lung dose. Herein, we define the iBCS classes quantitatively according to the dose number and permeability. The proposed iBCS was evaluated for its ability to categorize marketed inhaled drugs using data from the literature. The appropriateness of the classification of each drug was assessed based on published development, clinical and nonclinical data, and mechanistic physiologically based biopharmaceutics modeling. The inhaled drug product development challenges for each iBCS classification are discussed and illustrated for different classes of marketed inhaled drugs. Finally, it is recognized that discriminatory laboratory methods to characterize regional lung deposition, dissolution, and permeability will be key to fully realizing the benefits of an iBCS to streamline and derisk inhaled drug development.
Collapse
Affiliation(s)
- Jayne E. Hastedt
- JDP
Pharma Consulting, San Carlos, California 94070, United States
| | | | - Antonio Cabal
- Eisai, Woodcliff Lake, New Jersey 07677, United States
| | - Andy Clark
- Aerogen
Pharma, San Mateo, California 94402, United States
| | - Carsten Ehrhardt
- School
of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin D02 PN40, Ireland
| | - Ben Forbes
- King’s
College London, London SE1 9NH, U.K.
| | - Anthony J. Hickey
- University
of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
- RTI
International, Research Triangle
Park, North Carolina 27709, United States
| | | | - Wenlei Jiang
- Center
for Drug Evaluation and Research, Office of Generic Drugs, Office
of Research and Standards, U.S. FDA, Silver Spring, Maryland 20993, United States
| | | | - Philip J. Kuehl
- Lovelace Biomedical, Albuquerque, New Mexico 87108, United States
| | - David Prime
- Pulmonary Drug
Delivery Consultant, Ware Royston, SG8 7ED, U.K.
| | - Yoen-Ju Son
- Genentech, South
San Francisco, California 94080, United States
| | | | - Ulrika Tehler
- Advanced
Drug Delivery, Pharmaceutical Sciences, R&D, AstraZeneca, 431 83 Gothenburg, Sweden
| | - Jennifer Wylie
- Merck & Co., Inc., Rahway, New Jersey 07065, United States
| |
Collapse
|
5
|
Taylor G. The Pharmacokinetics of Inhaled Drugs. J Aerosol Med Pulm Drug Deliv 2023; 36:281-288. [PMID: 37851977 DOI: 10.1089/jamp.2023.29091.gt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
The pharmacokinetic (PK) profile of a drug after inhalation may differ quite markedly from that seen after dosing by other routes of administration. Drugs may be administered to the lung to elicit a local action or as a portal for systemic delivery of the drug to its site of action elsewhere in the body. Some knowledge of PK is important for both locally- and systemically-acting drugs. For a systemically-acting drug, the plasma concentration-time profile shares some similarities with drug given by the oral or intravenous routes, since the plasma concentrations (after the distribution phase) will be in equilibrium with concentrations at the site of action. For a locally-acting drug, however, the plasma concentrations reflect its fate after it has been absorbed and removed from the airways, and not what is available to its site of action in the lung. Consequently, those typical PK parameters which are determined from plasma concentration measurements, e.g., area under the curve (AUC), Cmax, tmax and post-peak t1/2 may provide information on the deposition and absorption of drugs from the lung; however, the information from these parameters becomes more complicated to decipher for those drugs which are locally-acting in the lung. Additionally, the plasma concentration profile for both locally- and systemically-acting drugs will not only reflect drug absorbed from the lung but also that absorbed from the gastrointestinal (GI) tract from the portion of the dose which is swallowed. This absorption from the GI tract adds a further complication to the interpretation of plasma concentrations, particularly for locally-acting drugs. The influence of physiological and pathological factors needs to be considered in the absorption of some inhaled drugs. The absorption of some hydrophilic drugs is influenced by the inspiratory maneuver used during initial inhalation of the drug, and at later times after deposition. Similarly, the effects of smoking have been shown to increase lung permeability and increase the absorption of certain hydrophilic drugs. The effects of different disease states of the lung have less defined influences on absorption into the systemic circulation.
Collapse
Affiliation(s)
- Glyn Taylor
- School of Pharmacy and Pharmaceutical Sciences, University of Cardiff, United Kingdom
| |
Collapse
|
6
|
Drescher SK, Jiao Y, Chen MJ, Kurumaddali A, Shao J, Amini E, Hochhaus G, Bulitta JB. Central and peripheral lung deposition of fluticasone propionate dry powder inhaler formulations in humans characterized by population pharmacokinetics. Pharm Res 2023; 40:1177-1191. [PMID: 37081302 PMCID: PMC10686290 DOI: 10.1007/s11095-023-03472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/12/2023] [Indexed: 04/22/2023]
Abstract
This study aimed to gain an in-depth understanding of the pulmonary fate of three experimental fluticasone propionate (FP) dry powder inhaler formulations which differed in mass median aerodynamic diameters (MMAD; A-4.5 µm, B-3.8 µm and C-3.7 µm; total single dose: 500 µg). Systemic disposition parameter estimates were obtained from published pharmacokinetic data after intravenous dosing to improve robustness. A biphasic pulmonary absorption model, with mucociliary clearance from the slower absorption compartment, and three systemic disposition compartments was most suitable. Rapid absorption, presumably from peripheral lung, had half-lives of 6.9 to 14.6 min. The peripherally deposited dose (12.6 µg) was significantly smaller for formulation A-4.5 µm than for the other formulations (38.7 and 39.3 µg for B-3.8 µm and C-3.7 µm). The slow absorption half-lives ranged from 6.86 to 9.13 h and were presumably associated with more central lung regions, where mucociliary clearance removed approximately half of the centrally deposited dose. Simulation-estimation studies showed that a biphasic absorption model could be reliably identified and that parameter estimates were unbiased and reasonably precise. Bioequivalence assessment of population pharmacokinetics derived central and peripheral lung doses suggested that formulation A-4.5 µm lacked bioequivalence compared to the other formulations both for central and peripheral doses. In contrast, the other fomulations were bioequivalent. Overall, population pharmacokinetics holds promise to provide important insights into the pulmonary fate of inhalation drugs, which are not available from non-compartmental analysis. This supports the assessment of the pulmonary bioequivalence of fluticasone propionate inhaled formulations through pharmacokinetic approaches, and may be helpful for discussions on evaluating alternatives to clinical endpoint studies.
Collapse
Affiliation(s)
- Stefanie K Drescher
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Box 100494, Gainesville, FL, 32610, USA
| | - Yuanyuan Jiao
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, FL, 32827, USA
| | - Mong-Jen Chen
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Box 100494, Gainesville, FL, 32610, USA
| | - Abhinav Kurumaddali
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Box 100494, Gainesville, FL, 32610, USA
| | - Jie Shao
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Box 100494, Gainesville, FL, 32610, USA
| | - Elham Amini
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Box 100494, Gainesville, FL, 32610, USA
| | - Günther Hochhaus
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Box 100494, Gainesville, FL, 32610, USA.
| | - Jürgen B Bulitta
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, FL, 32827, USA.
| |
Collapse
|
7
|
In Vitro Dissolution and Permeability Testing of Inhalation Products: Challenges and Advances. Pharmaceutics 2023; 15:pharmaceutics15030983. [PMID: 36986844 PMCID: PMC10059005 DOI: 10.3390/pharmaceutics15030983] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
In vitro dissolution and permeability testing aid the simulation of the in vivo behavior of inhalation drug products. Although the regulatory bodies have specific guidelines for the dissolution of orally administered dosage forms (e.g., tablets and capsules), this is not the case for orally inhaled formulations, as there is no commonly accepted test for assessing their dissolution pattern. Up until a few years ago, there was no consensus that assessing the dissolution of orally inhaled drugs is a key factor in the assessment of orally inhaled products. With the advancement of research in the field of dissolution methods for orally inhaled products and a focus on systemic delivery of new, poorly water-soluble drugs at higher therapeutic doses, an evaluation of dissolution kinetics is proving crucial. Dissolution and permeability testing can determine the differences between the developed formulations and the innovator’s formulations and serve as a useful tool in correlating in vitro and in vivo studies. The current review highlights recent advances in the dissolution and permeability testing of inhalation products and their limitations, including recent cell-based technology. Although a few new dissolution and permeability testing methods have been established that have varying degrees of complexity, none have emerged as the standard method of choice. The review discusses the challenges of establishing methods that can closely simulate the in vivo absorption of drugs. It provides practical insights into method development for various dissolution testing scenarios and challenges with dose collection and particle deposition from inhalation devices for dissolution tests. Furthermore, dissolution kinetic models and statistical tests to compare the dissolution profiles of test and reference products are discussed.
Collapse
|
8
|
Umeda A, Shimada H, Yamane T, Mochizuki T, Inoue Y, Tsushima K, Miyagawa K, Mochida A, Takeda H, Okada Y, Masaki K, Matsusaka M, Fukunaga K. Real-world effects of once-daily inhaled steroid (fluticasone furoate) combined with long-acting beta-2 agonist (vilanterol) and long-acting muscarinic antagonist (umeclidinium) on lung function tests of asthma patients in Japan. Front Physiol 2023; 14:1131949. [PMID: 37179838 PMCID: PMC10170765 DOI: 10.3389/fphys.2023.1131949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Background: The Japanese drug use system allowed the once-daily use of inhaled corticosteroid fluticasone furoate (FF) combined with a long-acting beta-2 agonist vilanterol (VI) and a long-acting muscarinic antagonist umeclidinium (UMEC) against asthma on 18 February 2021. We investigated the real-world effects of these drugs (FF/UMEC/VI) mainly on lung function tests. Methods: This was an open-label, uncontrolled, within-group time-series (before-after) study. Prior asthma treatment (inhaled corticosteroid with/without a long-acting beta-2 agonist with/without a long-acting muscarinic antagonist) was switched to FF/UMEC/VI 200/62.5/25 μg. Subjects were evaluated by lung function tests prior to, and 1-2 months after, initiation of FF/UMEC/VI 200/62.5/25 μg. Patients were asked questions regarding the asthma control test and preference for drugs. Results: Overall, 114 asthma outpatients (97% Japanese) were enrolled from February 2021 to April 2022: 104 subjects completed the study. Forced expiratory volume in 1 s, peak flow, and asthma control test score of FF/UMEC/VI 200/62.5/25 μg-treated subjects were significantly increased (p < 0.001, p < 0.001, and p < 0.01, respectively). In contrast with FF/VI 200/25 μg, instantaneous flow at 25% of the forced vital capacity and expiratory reserve volume were significantly increased by FF/UMEC/VI 200/62.5/25 μg (p < 0.01, p < 0.05, respectively). Sixty-six percent of subjects declared they wanted to continue FF/UMEC/VI 200/62.5/25 μg in the future. Adverse effects, mainly local, were seen in 30% of patients, but no serious adverse effects were seen. Conclusion: Once-daily FF/UMEC/VI 200/62.5/25 μg was effective against asthma without serious adverse events. This is the first report that demonstrated FF/UMEC/VI dilated peripheral airways using lung function tests. This evidence on drug effects may improve our understanding of pulmonary physiology and the pathophysiology of asthma.
Collapse
Affiliation(s)
- Akira Umeda
- Department of General Medicine, School of Medicine, International University of Health and Welfare (IUHW), IUHW Shioya Hospital, Yaita, Japan
- Department of Respiratory Medicine, IUHW Shioya Hospital, Yaita, Japan
- *Correspondence: Akira Umeda,
| | - Hisato Shimada
- Department of Respiratory Medicine, IUHW Shioya Hospital, Yaita, Japan
| | - Tateki Yamane
- Department of Digestive Organ, IUHW Shioya Hospital, Yaita, Japan
| | | | - Yasushi Inoue
- Respiratory Diseases Center, IUHW Mita Hospital, Tokyo, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Kazuya Miyagawa
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Otawara, Japan
| | - Atsumi Mochida
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Otawara, Japan
| | - Hiroshi Takeda
- Department of Pharmacology, School of Pharmacy at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Yasumasa Okada
- Department of Internal Medicine, National Hospital Organization Murayama Medical Center, Musashimurayama, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University, Tokyo, Japan
| | - Masako Matsusaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University, Tokyo, Japan
| |
Collapse
|
9
|
Brattsand R, Selroos O. May a different kinetic mode explain the high efficacy/safety profile of inhaled budesonide? Pulm Pharmacol Ther 2022; 77:102167. [PMID: 36180011 DOI: 10.1016/j.pupt.2022.102167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
The claimed functional basis for ICSs in asthma and COPD is airway selectivity, attained by inhaling a potent, lipophilic compound with long local dissolution/absorption time. The development has been empirically based, resulting in five widely used ICSs. Among them, budesonide (BUD) deviates by being less lipophilic, leading to a more rapid systemic uptake with plasma peaks with some systemic anti-inflammatory activity. By this, BUD fits less well into the current pharmacological dogma of optimal ICS profile. In this review we compared the physicochemical, pharmacological and clinical properties of BUD, fluticasone propionate (FP) and fluticasone furoate (FF), representing different levels of lipophilicity, airway and systemic kinetics, focusing on their long-acting β2-agonist (LABA) combinations, in line with current GINA and GOLD recommendations. We are aware of the differences between formoterol (FORM) and the not rapid acting LABAs such as e.g. salmeterol and vilanterol but our comparisons are based on currently available combination products. A beclomethasone dipropionate (BDP)/FORM combination is also commented upon. Based on clinical comparisons in asthma and COPD, we conclude that the BUD/formoterol (BUD/FORM) combination is as effective and safe as the FP and FF combinations, and is in some cases even better as it can be used as "maintenance plus reliever therapy" (MART) in asthma and as maintenance in COPD. This is difficult to explain by current views of required ICS's/LABAs pharmacokinetic profiles. We propose that BUD achieves its efficacy by a combination of airway and systemic activity. The airway activity is dominating. The systemic activity contributes by plasma peaks, which are high enough for supportive anti-inflammatory actions at the blood and bone marrow levels but not sufficiently long to trigger a similar level of systemic adverse effects. This may be due to BUD's capacity to exploit a systemic differentiation mechanism as programmed for cortisol's various actions. This differentiation prospect can be reached only for an ICS with short plasma half-life. Here we present an alternative mode for an ICS to reach combined efficacy and safety, based on a poorly investigated and exploited physiological mechanism. A preference of this mode is broader versatility, due to that its straighter dose-response should allow a better adaptation to disease fluctuations, and that its rapid activity enables use as "anti-inflammatory reliever".
Collapse
Affiliation(s)
- Ralph Brattsand
- Experimental Pharmacology, Budera Company, Kristinehamn, Sweden.
| | | |
Collapse
|
10
|
Martínez-García MÁ, Oscullo G, García-Ortega A, Matera MG, Rogliani P, Cazzola M. Inhaled Corticosteroids in Adults with Non-cystic Fibrosis Bronchiectasis: From Bench to Bedside. A Narrative Review. Drugs 2022; 82:1453-1468. [PMID: 36264441 PMCID: PMC9626424 DOI: 10.1007/s40265-022-01785-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
Due to their potent anti-inflammatory capacity (particularly in predominantly eosinophilic inflammation) and immunosuppressive properties, inhaled corticosteroids (ICSs) are widely used in asthmatic patients and also in individuals with chronic obstructive pulmonary disease (COPD) who suffer multiple exacerbations or have peripheral eosinophilia. However, there is little evidence for their use in non-cystic fibrosis bronchiectasis (hereafter, bronchiectasis). According to data extracted from large databases of bronchiectasis in adults, ICSs are used in more than 50% of patients without any scientific evidence to justify their efficacy and contrary to the recommendations of international guidelines on bronchiectasis that generally advise against their use. Indeed, bronchiectasis is a disease with predominantly neutrophilic inflammation and a high likelihood of chronic bacterial bronchial infection. Furthermore, it is known that due to their immunosuppressive properties, ICSs can induce an increase in bacterial infections. This manuscript aims to review the basic properties of ICSs, how they impact bronchiectasis in adults, the current position of international guidelines on this treatment, and the current indications and future challenges related to ICS use in bronchiectasis.
Collapse
Affiliation(s)
- Miguel Ángel Martínez-García
- Respiratory Department, Politechnic and University La Fe Hospital, Valencia, Spain
- CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - Grace Oscullo
- Respiratory Department, Politechnic and University La Fe Hospital, Valencia, Spain
| | | | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| |
Collapse
|
11
|
Lipworth B, Misirovs R, Chan R. Adrenal insufficiency in patients taking benralizumab as corticosteroid sparing therapy. THE LANCET RESPIRATORY MEDICINE 2021; 10:e7. [PMID: 34762848 DOI: 10.1016/s2213-2600(21)00487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Rasads Misirovs
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| |
Collapse
|
12
|
Scotney E, Burchett S, Goddard T, Saglani S. Pediatric problematic severe asthma: Recent advances in management. Pediatr Allergy Immunol 2021; 32:1405-1415. [PMID: 34002877 DOI: 10.1111/pai.13543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
Problematic severe asthma remains a significant challenge to manage, accounting for the majority of healthcare utilization among children with asthma. The heterogeneity is recognized and the clinical phenotypes of "difficult-to-treat" asthma (DA) and "severe therapy-resistant asthma" (STRA) help to guide management. Recent evidence supports molecular distinctions between these phenotypes and shows poor correlations between peripheral and airway markers of inflammation, especially in STRA. Airway neutrophils in the context of childhood severe asthma have been explored, but their role in disease causation, protection, or as bystanders remain unknown, and thus, treatment implications are unclear. Several novel management strategies, including once-daily maintenance therapy, single-device maintenance and reliever therapy, and novel biological treatments are being increasingly used for DA and STRA. However, pediatric data for efficacy of novel treatments is scarce, and when available, is restricted to adolescents. The aim of this review is to highlight recent advances in objective biomarkers that aid stratification and management of childhood severe asthma and to highlight gaps in pediatric evidence. Specifically, the urgent need for efficacy studies to improve the management of problematic severe asthma in children younger than 12 years.
Collapse
Affiliation(s)
- Elizabeth Scotney
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Saskia Burchett
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Thomas Goddard
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,The University of Adelaide, Adelaide, Australia
| | - Sejal Saglani
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| |
Collapse
|
13
|
Abstract
Synthetic glucocorticoids are widely used for their anti-inflammatory and immunosuppressive actions. A possible unwanted effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal axis, which can lead to adrenal insufficiency. Factors affecting the risk of glucocorticoid induced adrenal insufficiency (GI-AI) include the duration of glucocorticoid therapy, mode of administration, glucocorticoid dose and potency, concomitant drugs that interfere with glucocorticoid metabolism, and individual susceptibility. Patients with exogenous glucocorticoid use may develop features of Cushing's syndrome and, subsequently, glucocorticoid withdrawal syndrome when the treatment is tapered down. Symptoms of glucocorticoid withdrawal can overlap with those of the underlying disorder, as well as of GI-AI. A careful approach to the glucocorticoid taper and appropriate patient counseling are needed to assure a successful taper. Glucocorticoid therapy should not be completely stopped until recovery of adrenal function is achieved. In this review, we discuss the factors affecting the risk of GI-AI, propose a regimen for the glucocorticoid taper, and make suggestions for assessment of adrenal function recovery. We also describe current gaps in the management of patients with GI-AI and make suggestions for an approach to the glucocorticoid withdrawal syndrome, chronic management of glucocorticoid therapy, and education on GI-AI for patients and providers.
Collapse
Affiliation(s)
- Alessandro Prete
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Irina Bancos
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
14
|
Lee HW, Kim HJ, Jang EJ, Lee CH. Comparisons of Efficacy and Safety between Triple (Inhaled Corticosteroid/Long-Acting Muscarinic Antagonist/Long-Acting Beta-Agonist) Therapies in Chronic Obstructive Pulmonary Disease: Systematic Review and Bayesian Network Meta-Analysis. Respiration 2021; 100:631-643. [PMID: 33971649 DOI: 10.1159/000515133] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Various combinations of inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta-agonist (LABA) have been used as triple therapy for stable chronic obstructive pulmonary disease (COPD). OBJECTIVE Our study was conducted to answer whether there were significant differences among various combinations in efficacy, for reducing exacerbation or mortality, and in safety, for increasing cardiovascular events or pneumonia. METHOD We searched parallel-group randomized controlled trials (RCTs) comparing ICS/LAMA/LABA with other inhaled drugs in patients with stable COPD for at least 12 weeks in PubMed, EMBASE, the Cochrane Library, and clinical trial registries from inception to December 31, 2019. We conducted a network meta-analysis with Bayesian statistics using a random-effects model with heterogeneous variance structure (PROSPERO, CRD42019126757). RESULTS Nine different combinations of ICS/LAMA/LABA were identified in 21 RCTs containing 29,892 patients with moderate to very severe COPD. We could not find any significant evidence suggesting a better treatment for reducing total exacerbations or all-cause mortality among ICS/LAMA/LABA combinations. There were also no significant differences in moderate to severe exacerbation, COPD-related mortality, or cardiovascular disease-related mortality among ICS/LAMA/LABA combinations, and the risk of major adverse cardiovascular events was not different. A significantly lower risk of pneumonia was found in fluticasone propionate (FP)/glycopyrrolate/salmeterol (SAL) than FP/tiotropium/SAL {median odds ratio [OR] (95% credible interval [CrI]) = 0 [0-0.72]} and FP/umeclidinium/SAL {median OR (95% Crl) = 0 [0-0.97]}. CONCLUSION There were no significant differences in clinical outcomes, including acute exacerbation and all-cause mortality among various ICS/LAMA/LABA combinations in patients with moderate to very severe COPD.
Collapse
Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Republic of Korea
| | - Hyung Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea
| |
Collapse
|
15
|
Drivers of absolute systemic bioavailability after oral pulmonary inhalation in humans. Eur J Pharm Biopharm 2021; 164:36-53. [PMID: 33895293 DOI: 10.1016/j.ejpb.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022]
Abstract
There are few studies in humans dealing with the relationship between physico-chemical properties of drugs and their systemic bioavailability after administration via oral inhalation route (Fpulm). Getting further insight in the determinants of Fpulm after oral pulmonary inhalation could be of value for drugs considered for a systemic delivery as a result of poor oral bioavailability, as well as for drugs considered for a local delivery to anticipate their undesirable systemic effects. To better delineate the parameters influencing the systemic delivery after oral pulmonary inhalation in humans, we studied the influence of physico-chemical and permeability properties obtained in silico on the rate and extent of Fpulm in a series of 77 compounds with or without marketing approval for pulmonary delivery, and intended either for local or for systemic delivery. Principal component analysis (PCA) showed mainly that Fpulm was positively correlated with Papp and negatively correlated with %TPSA, without a significant influence of solubility and ionization fraction, and no apparent link with lipophilicity and drug size parameters. As a result of the small sample set, the performance of the different models as predictive of Fpulm were quite average with random forest algorithm displaying the best performance. As a whole, the different models captured between 50 and 60% of the variability with a prediction error of less than 20%. Tmax data suggested a significant positive influence of lipophilicity on absorption rate while charge apparently had no influence. A significant linear relationship between Cmax and dose (R2 = "0.79) highlighted that Cmax was primarily dependent on dose and absorption rate and could be used to estimate Cmax in humans for new inhaled drugs.
Collapse
|
16
|
Lipworth B, Chan R, Kuo CRW. End-point selection to determine the airway-systemic ratio of inhaled corticosteroids in asthma. Br J Clin Pharmacol 2020; 87:2401-2402. [PMID: 33230858 DOI: 10.1111/bcp.14633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/17/2020] [Accepted: 10/24/2020] [Indexed: 11/27/2022] Open
Abstract
The use of adenosine monophosphate challenge and basal cortisol as short-term surrogate end points of airway-systemic effects of inhaled corticosteroids in asthma is not suitable to properly determine the clinically relevant long-term therapeutic index.
Collapse
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School University of Dundee, UK
| | - Rory Chan
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School University of Dundee, UK
| | - Chris Rui Wen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School University of Dundee, UK
| |
Collapse
|
17
|
Eriksson J, Thörn H, Lennernäs H, Sjögren E. Pulmonary drug absorption and systemic exposure in human: Predictions using physiologically based biopharmaceutics modeling. Eur J Pharm Biopharm 2020; 156:191-202. [DOI: 10.1016/j.ejpb.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
|
18
|
Raut A, Dhapare S, Venitz J, Sakagami M. Pharmacokinetic profile analyses for inhaled drugs in humans using the lung delivery and disposition model. Biopharm Drug Dispos 2019; 41:32-43. [PMID: 31691979 DOI: 10.1002/bdd.2210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/09/2019] [Accepted: 10/27/2019] [Indexed: 11/09/2022]
Abstract
The kinetic clarification of lung disposition for inhaled drugs in humans via pharmacokinetic (PK) modeling aids in their development and regulation for systemic and local delivery, but remains challenging due to its multiplex nature. This study exercised our lung delivery and disposition kinetic model to derive the kinetic descriptors for the lung disposition of four drugs [calcitonin, tobramycin, ciprofloxacin and fluticasone propionate (FP)] inhaled via different inhalers from the published PK profile data. With the drug dose delivered to the lung (DTL) estimated from the corresponding γ-scintigraphy or in vivo predictive cascade impactor data, the model-based curve-fitting and statistical moment analyses derived the rate constants of lung absorption (ka ) and non-absorptive disposition (knad ). The ka values differed substantially between the drugs (0.05-1.00 h-1 ), but conformed to the lung partition-based membrane diffusion except for FP, and were inhaler/delivery/deposition-independent. The knad values also varied widely (0.03-2.32 h-1 ), yet appeared to be explained by the presence or absence of non-absorptive disposition in the lung via mucociliary clearance, local tissue degradation, binding/sequestration and/or phagocytosis, and to be sensitive to differences in lung deposition. For FP, its ka value of 0.2 h-1 was unusually low, suggesting solubility/dissolution-limited slow lung absorption, but was comparable between two inhaler products. Thus, the difference in the PK profile was attributed to differences in the DTL and the knad value, the latter likely originating from different aerosol sizes and regional deposition in the lung. Overall, this empirical, rather simpler model-based analysis provided a quantitative kinetic understanding of lung absorption and non-absorptive disposition for four inhaled drugs from PK profiles in humans.
Collapse
Affiliation(s)
- Anuja Raut
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, P.O. Box 980533, Richmond, VA, 23298, USA
| | - Sneha Dhapare
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, P.O. Box 980533, Richmond, VA, 23298, USA
| | - Jürgen Venitz
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, P.O. Box 980533, Richmond, VA, 23298, USA
| | - Masahiro Sakagami
- Department of Pharmaceutics, School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street, P.O. Box 980533, Richmond, VA, 23298, USA
| |
Collapse
|
19
|
Abstract
Airway inflammation is a major contributing factor in both asthma and chronic obstructive pulmonary disease (COPD) and represents an important target for treatment. Inhaled corticosteroids (ICS) as monotherapy or in combination therapy with long-acting β2-agonists or long-acting muscarinic antagonists are used extensively in the treatment of asthma and COPD. The development of ICS for their anti-inflammatory properties progressed through efforts to increase topical potency and minimise systemic potency and through advances in inhaled delivery technology. Budesonide is a potent, non-halogenated ICS that was developed in the early 1970s and is now one of the most widely used lung medicines worldwide. Inhaled budesonide's physiochemical and pharmacokinetic/pharmacodynamic properties allow it to reach a rapid and high airway efficacy due to its more balanced relationship between water solubility and lipophilicity. When absorbed from the airways and lung tissue, its moderate lipophilicity shortens systemic exposure, and its unique property of intracellular esterification acts like a sustained release mechanism within airway tissues, contributing to its airway selectivity and a low risk of adverse events. There is a large volume of clinical evidence supporting the efficacy and safety of budesonide, both alone and in combination with the fast- and long-acting β2-agonist formoterol, as maintenance therapy in patients with asthma and with COPD. The combination of budesonide/formoterol can also be used as an as-needed reliever with anti-inflammatory properties, with or without regular maintenance for asthma, a novel approach that is already approved by some country-specific regulatory authorities and currently recommended in the Global Initiative for Asthma (GINA) guidelines. Budesonide remains one of the most well-established and versatile of the inhaled anti-inflammatory drugs. This narrative review provides a clinical reappraisal of the benefit:risk profile of budesonide in the management of asthma and COPD.
Collapse
Affiliation(s)
- Donald P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1690, USA.
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Ralph Brattsand
- Experimental Pharmacology, Budera Company, Kristinehamn, Sweden
| |
Collapse
|
20
|
Patel D, Namdev KK, Verma K, Gururani R, Tiwari A, Kumar P, Dewangan RP, Wabaidur SM, Sharma S, Dwivedi J. HPLC-UV and spectrofluorimetric methods for simultaneous estimation of fluticasone furoate and vilanterol in rabbit plasma: A pharmacokinetic study. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1132:121842. [PMID: 31669821 DOI: 10.1016/j.jchromb.2019.121842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022]
Abstract
Fluticasone furoate (FF) and vilanterol trifenatate (VT) is a widely prescribed combination in the management of asthma and chronic obstructive pulmonary disease. In the present study, two quantitative methods based on HPLC-UV and spectrofluorimetric analysis had been developed and validated for simultaneous estimation of FF and VT in rabbit plasma using baclomethasone as internal standard (ISTD). Analytes and ISTD were separated from plasma using simple step of protein precipitation with acetonitrile. Chromatographic separation was achieved on Spherisorb S5 ODS2 (250 mm × 4.6 mm, 5.0 µm) column using mobile phase that constitute acetonitrile-0.01% glacial acetic acid in water (70:30, v/v) and then detected on a UV detector at 235 nm wavelength. Spectrofluorimetric detection was performed using absorption/emission wavelength (λabs/em) of 286/352 nm and 362/407 nm for FF and VT, respectively. For both analytes, linearity ranged from 4-200 ng/mL to 10-200 ng/mL using HPLC-UV and spectrofluorimetric method, respectively. Methods were validated as per FDA recommendations. Statistical analysis revealed that these detection methods are statistically insignificant difference and can be used interchangeably without any bias. Further, these methods were applied in pharmacokinetic study for simultaneous estimation of FF and VT in rabbit plasma.
Collapse
Affiliation(s)
- Durgawati Patel
- Department of Chemistry, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India
| | - Kuldeep Kumar Namdev
- Department of Chemistry, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India
| | - Kanika Verma
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India
| | - Ritika Gururani
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India
| | - Akansha Tiwari
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India
| | - Puspendra Kumar
- KIET School of Pharmacy, KIET Group of Institutions, Ghaziabad, Uttar Pradesh 201206, India
| | - Rikeshwer Prasad Dewangan
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Saikh Mohammad Wabaidur
- Department of Chemistry, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India; Advanced Materials Research Chair, Department of Chemistry, King Saud University, Riyadh, Saudi Arabia
| | - Swapnil Sharma
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India.
| | - Jaya Dwivedi
- Department of Chemistry, Banasthali Vidyapith, Banasthali, Rajasthan 304022, India.
| |
Collapse
|
21
|
Furuhashi K, Fujisawa T, Hashimoto D, Kamiya Y, Yasui H, Karayama M, Suzuki Y, Hozumi H, Enomoto N, Nakamura Y, Inui N, Suda T. Once-daily fluticasone furoate/vilanterol combination versus twice-daily budesonide/formoterol combination in the treatment of controlled stable asthma: a randomized crossover trial. J Asthma Allergy 2019; 12:253-261. [PMID: 31571932 PMCID: PMC6756272 DOI: 10.2147/jaa.s223093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Fluticasone furoate (FF)/vilanterol (VI) dry powder inhaler (DPI) is the only once-daily maintenance inhaled corticosteroid (ICS)/long-acting β2 adrenergic agonist (LABA) combination for asthma. We aimed to compare the clinical effects of once-daily FF/VI and twice-daily budesonide (BUD)/formoterol (FM) DPI in patients with controlled stable asthma. Methods We performed a randomized crossover trial in which stable asthmatic patients controlled on ICS/LABA received 8 weeks of FF/VI (100/25 μg 1 puff once-daily) or BUD/FM (160/4.5 μg 2 puffs twice-daily) DPI treatment. After a 4–8-week washout period, patients received another crossover treatment for 8 weeks. We assessed pulmonary function, the 5-item version asthma control questionnaire (ACQ5), the asthma control test (ACT), and fractional exhaled nitric oxide (FeNO) at baseline and after 8 weeks of treatment (week 8). As the primary outcome was change in force expiratory volume in 1 s (FEV1) between baseline and week 8, we evaluated the incidence of asthma exacerbation and adherence barrier questionnaire (Ask-12) at week 8. Results Twenty-three patients were initially enrolled in this study; however, one patient had to be excluded. The FF/VI DPI treatment group showed a similar magnitude of change in FEV1 between baseline and week 8 as the BUD/FM DPI treatment group. In addition, there were no significant differences in pulmonary function tests, ACQ5 scores, ACT scores, and FeNO between baseline and week 8 in both groups. Although the incidence of exacerbation did not differ between groups, the Ask-12 score in the FF/VI DPI group was significantly lower than that in the BUD/FM DPI group. Conclusions The present study indicates that once-daily FF/VI DPI is not inferior to twice-daily BUD/FM DPI in clinical effect and more likely to improve inconvenience and forgetfulness in inhalation adherence barriers for stable asthma control therapy. Once-daily FF/VI DPI may be an effective alternative for asthma maintenance treatment.
Collapse
Affiliation(s)
- Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Dai Hashimoto
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yousuke Kamiya
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
22
|
Matera MG, Rinaldi B, Calzetta L, Rogliani P, Cazzola M. Pharmacokinetics and pharmacodynamics of inhaled corticosteroids for asthma treatment. Pulm Pharmacol Ther 2019; 58:101828. [PMID: 31349002 DOI: 10.1016/j.pupt.2019.101828] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
Abstract
The differences in the pharmacokinetic (PK) characteristics of inhaled corticosteroids (ICSs) critically influence the profile of each of them, but also the significant differences in glucocorticoid receptor selectivity, potency, and physicochemical properties are critical in defining the pharmacodynamic (PD) profile of an ICS. The PK and PD properties of ICSs used in asthma and the importance of their interrelationship have been reviewed. The differences among the ICSs in PK and PD must be considered when an ICS should be prescribed to an asthmatic patient because a better understanding of the PK/PD interrelationship of ICSs could be important to better fit with the between-patient variability and within-patient repeatability in the response to ICSs that often complicate the therapeutic approach to the asthmatic patient. The role of the device in influencing the PK profile of an ICS must be always considered because it is crucial. Also patient-related factors and disease severity affect pulmonary deposition of ICS.
Collapse
Affiliation(s)
- Maria Gabriella Matera
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Naples, Italy
| | - Barbara Rinaldi
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Naples, Italy
| | - Luigino Calzetta
- University of Rome "Tor Vergata", Department of Experimental Medicine, Rome, Italy
| | - Paola Rogliani
- University of Rome "Tor Vergata", Department of Experimental Medicine, Rome, Italy
| | - Mario Cazzola
- University of Rome "Tor Vergata", Department of Experimental Medicine, Rome, Italy.
| |
Collapse
|
23
|
Velepič M, Manestar D, Perković I, Škalamera D, Braut T. Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study. J Clin Pharmacol 2019; 59:1648-1655. [DOI: 10.1002/jcph.1471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/31/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Marko Velepič
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | | | - Ivona Perković
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | - Dunja Škalamera
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| | - Tamara Braut
- Clinic of Otorhinolaryngology Head and Neck SurgeryClinical Medical Centre, University of Rijeka Rijeka Croatia
| |
Collapse
|
24
|
Umeda A, Yamane T, Mochizuki T, Inoue Y, Tsushima K, Miyagawa K, Mochida A, Takeda H, Okada Y, Fukunaga K. Real-world efficacy and problems of once-daily use of inhaled steroid (fluticasone furoate) combined with long-acting beta-2 agonist (vilanterol) in Japanese patients with asthma. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1600632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Akira Umeda
- Department of Internal Medicine, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita, Japan
| | - Tateki Yamane
- Department of Internal Medicine, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita, Japan
| | - Taichi Mochizuki
- Department of Internal Medicine, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita, Japan
- Respiratory Diseases Center, IUHW Mita Hospital, Tokyo, Japan
| | - Yasushi Inoue
- Department of Internal Medicine, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita, Japan
- Respiratory Diseases Center, IUHW Mita Hospital, Tokyo, Japan
| | - Kenji Tsushima
- Department of Internal Medicine, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita, Japan
- Department of Pulmonary Medicine, School of Medicine, IUHW, Narita, Japan
| | - Kazuya Miyagawa
- Department of Pharmacology, School of Pharmacy, IUHW, Otawara, Japan
| | - Atsumi Mochida
- Department of Pharmacology, School of Pharmacy, IUHW, Otawara, Japan
| | - Hiroshi Takeda
- Department of Pharmacology, School of Pharmacy, IUHW, Otawara, Japan
| | - Yasumasa Okada
- Department of Internal Medicine, National Hospital Organization Murayama Medical Center, Musashimurayama, Japan
| | - Koich Fukunaga
- Department of Respiratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| |
Collapse
|
25
|
Lal C, Strange C. Evaluating fluticasone furoate + vilanterol for the treatment of chronic obstructive pulmonary disease (COPD). Expert Opin Pharmacother 2019; 20:1075-1085. [PMID: 30983423 DOI: 10.1080/14656566.2019.1603292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Inhaled corticosteroid/long-acting β-2 agonists (ICS/LABA) combination inhalers have been a lifeline for a generation of chronic obstructive pulmonary disease (COPD) and asthma patients. Fluticasone furoate and Vilanterol (FF/VI) as a once-daily ICS/LABA combination have an extensive clinical trial and real-world data to support its use in COPD patients. Areas covered: The authors provide pharmacological profiles of fluticasone furoate, vilanterol and the FF/VI fixed dose combination. Salient clinical trials evaluating efficacy and safety of the FF/VI combination, and studies demonstrating the impact on COPD exacerbation risk and mortality are also discussed. Expert opinion: ICS/LABA combinations provide bronchodilation and decrease the frequency of COPD exacerbations. Individualizing treatment of each COPD patient based on unique phenotypes will maximize chances of therapeutic responsiveness. Asthma-COPD overlap (ACO), patients with sputum and/or blood eosinophilia, patients with a brisk bronchodilator response, and patients with frequent exacerbations are more likely to show a therapeutic response to ICS than populations who have none of these features. FF/VI will likely remain a popular ICS/LBA combination to treat COPD, as a once-daily inhaled therapy delivered via the Ellipta device popular with COPD patients, with extensive clinical trial and real-world data to support its use.
Collapse
Affiliation(s)
- Chitra Lal
- a Pulmonary, Critical Care, Allergy and Sleep Medicine , Medical University of South Carolina , Charleston , SC , USA
| | - Charlie Strange
- a Pulmonary, Critical Care, Allergy and Sleep Medicine , Medical University of South Carolina , Charleston , SC , USA
| |
Collapse
|
26
|
Parri G, Nieri D, Roggi MA, Vagaggini B, Celi A, Paggiaro P. Fluticasone furoate, umeclidinium bromide, and vilanterol as a combination therapy for chronic obstructive pulmonary disease. Expert Rev Respir Med 2018; 12:997-1005. [PMID: 30463451 DOI: 10.1080/17476348.2018.1548936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Triple therapy with two bronchodilators (LABA plus LAMA) and an inhaled corticosteroid (ICS) is recommended for patients suffering from severe chronic obstructive pulmonary disease (COPD). Areas covered: All 12-52 week-long studies comparing triple therapy with umeclidinium (UM) added to either fluticasone furoate/vilanterol (FF/VI) or fluticasone propionate/salmeterol (FP/SAL) vs. other comparators in COPD patients of group B or D (2011 GOLD classification) were considered. When UM was added to ICS/LABA with separate devices or within a single device, triple combination was more effective than comparators (usually, ICS/LABA combinations) regarding improvements to pulmonary function, symptoms, quality of life and, in the longer studies, rate of moderate-severe exacerbations. The IMPACT study (a large trial comparing UM/FF/VI with both FF/VI and UM/VI combinations) showed that triple therapy had a greater effect compared to dual therapies in reducing the rate of moderate-severe exacerbations, improving trough FEV1 and improving quality of life. The safety profile was good, without excess cardiovascular effects or pneumonia, however, the presence of comorbidities was frequent. Expert commentary: UM/FF/VI combination represents a good option for severe COPD patients who remain symptomatic and/or with frequent exacerbations despite dual therapies. Once daily administration with a simple and effective device may increase adherence and efficacy of the treatment.
Collapse
Affiliation(s)
- Giulia Parri
- a Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| | - Dario Nieri
- b Bronchology and bronchial endoscopy unit, Department of medical specialties , S. Maria Annunziata hospital , Bagno a Ripoli (Florence) , Italy
| | - Maria Adelaide Roggi
- a Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| | - Barbara Vagaggini
- a Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| | - Alessandro Celi
- a Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| | - Pierluigi Paggiaro
- a Department of Surgery, Medicine, Molecular Biology and Critical Care , University of Pisa , Pisa , Italy
| |
Collapse
|
27
|
Li Y, Li H, Sheng Y, Du X, Yao Y, Luo X, Ma P. Pharmacokinetics of Single and Repeat Doses of Fluticasone Furoate/Umeclidinium/Vilanterol in Healthy Chinese Adults. Clin Pharmacol Drug Dev 2018; 8:721-733. [PMID: 30427594 DOI: 10.1002/cpdd.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/08/2018] [Indexed: 11/10/2022]
Abstract
The pharmacokinetics (PK) and safety of single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) after single and repeat dosing in healthy Chinese adults were assessed. In this open-label study (NCT02837380), subjects received once-daily FF/UMEC/VI 100/62.5/25 µg on day 1 and repeat doses on days 2-7. PK parameters (days 1 and 7) included maximum observed concentration (Cmax ) and area under the plasma concentration-time curve (AUC) from time zero (predose) to last time of quantifiable concentration (AUC0-t ). Terminal phase half-life (t½ ) on day 1 was estimated. The primary objective was to assess systemic exposure of FF 100 µg, UMEC 62.5 µg, and VI 25 µg following single-inhaler triple therapy on days 1 and 7. On day 1, geometric mean t½ of UMEC and VI was 0.36 and 0.52 hours, respectively; t½ of FF was not representative because of nonquantifiable concentration data. On days 1 and 7, geometric mean Cmax of FF was 10.46 and 27.32 pg/mL, respectively; Cmax of UMEC was 144.14 and 241.35 pg/mL, respectively; and Cmax of VI was 120.42 and 196.78 pg/mL, respectively. AUC0-t of FF was 1.77 and 276.96 pg·h/mL, respectively; AUC0-t of UMEC was 28.44 and 117.19 pg·h/mL, respectively; and AUC0-t of VI, 42.46 and 101.12 pg·h/mL, respectively. The PK of FF/UMEC/VI was as expected for the individual-component PK previously reported in healthy Chinese adults. No new safety signals were observed.
Collapse
Affiliation(s)
- Yan Li
- Shanghai Mental Health Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Xuhui Qu, Shanghai, China
| | - Huafang Li
- Shanghai Mental Health Center, Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Xuhui Qu, Shanghai, China
| | - Yucheng Sheng
- Research and Development, GSK, Pudong Xinqu, Shanghai, China
| | - Xin Du
- Research and Development, GSK, Chaoyang District, Beijing, China
| | - Yuhui Yao
- Research and Development, GSK, Pudong Xinqu, Shanghai, China
| | - Xian Luo
- Research and Development, GSK, Pudong Xinqu, Shanghai, China
| | - Peiming Ma
- Research and Development, GSK, Pudong Xinqu, Shanghai, China
| |
Collapse
|
28
|
Franek F, Fransson R, Thörn H, Bäckman P, Andersson PU, Tehler U. Ranking in Vitro Dissolution of Inhaled Micronized Drug Powders including a Candidate Drug with Two Different Particle Sizes. Mol Pharm 2018; 15:5319-5326. [DOI: 10.1021/acs.molpharmaceut.8b00796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Frans Franek
- Pharmaceutical Technology & Development Inhalation, Operations, AstraZeneca R&D, Pepparedsleden 1, Mölndal 43183, Sweden
| | - Rebecca Fransson
- Pharmaceutical Sciences, IMED, AstraZeneca R&D, Pepparedsleden 1, Mölndal 43183, Sweden
| | - Helena Thörn
- Pharmaceutical Technology & Development Inhalation, Operations, AstraZeneca R&D, Pepparedsleden 1, Mölndal 43183, Sweden
| | - Per Bäckman
- Pharmaceutical Technology & Development Inhalation, Operations, AstraZeneca R&D, Pepparedsleden 1, Mölndal 43183, Sweden
| | - Patrik U. Andersson
- Pharmaceutical Technology & Development Inhalation, Operations, AstraZeneca R&D, Pepparedsleden 1, Mölndal 43183, Sweden
| | - Ulrika Tehler
- Pharmaceutical Sciences, IMED, AstraZeneca R&D, Pepparedsleden 1, Mölndal 43183, Sweden
| |
Collapse
|
29
|
Lipworth B, Kuo CR, Jabbal S. Inhaled triple therapy in chronic obstructive pulmonary disease. Lancet 2018; 392:1112-1113. [PMID: 30303075 DOI: 10.1016/s0140-6736(18)31795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland DD1 9SY, UK.
| | - Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland DD1 9SY, UK
| | - Sunny Jabbal
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland DD1 9SY, UK
| |
Collapse
|
30
|
Lipworth B, Kuo CR, Jabbal S. Current appraisal of single inhaler triple therapy in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3003-3009. [PMID: 30319248 PMCID: PMC6167973 DOI: 10.2147/copd.s177333] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A single inhaler containing inhaled corticosteroid (ICS)/long-acting beta-agonist (LABA)/long-acting muscarinic antagonist (LAMA) is a more convenient way of delivering triple therapy in patients with COPD. Single triple therapy has been shown to be superior at reducing exacerbations and improving quality of life compared to LABA/LAMA, especially in patients with a prior history of frequent exacerbations and blood eosinophilia, who have ICS responsive disease. The corollary is that patients with infrequent exacerbations who are noneosinophilic may be safely de-escalated from triple therapy to LABA/LAMA without loss of control. Pointedly, there is a substantially increased risk of pneumonia associated with the triple therapy containing fluticasone furoate but not beclometasone dipropionate or budesonide. Since triple therapy is also better than ICS/LABA at reducing exacerbations and improving lung function, symptoms, and quality of life, this brings into question the rationale for using ICS/LABA. Hence, we propose a simplified pragmatic decision process based on symptoms, prior to exacerbation history, and blood eosinophils to select which patients should be given a single triple inhaler or LABA/LAMA. Differences in patient preference of inhaler device, formulations and drugs will also determine which triple inhaler prescribers elect to use.
Collapse
Affiliation(s)
- Brian Lipworth
- Division of Molecular & Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK,
| | - Chris RuiWen Kuo
- Division of Molecular & Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK,
| | - Sunny Jabbal
- Division of Molecular & Clinical Medicine, Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK,
| |
Collapse
|
31
|
Procopiou PA, Anderson NA, Barrett J, Barrett TN, Crawford MHJ, Fallon BJ, Hancock AP, Le J, Lemma S, Marshall RP, Morrell J, Pritchard JM, Rowedder JE, Saklatvala P, Slack RJ, Sollis SL, Suckling CJ, Thorp LR, Vitulli G, Macdonald SJF. Discovery of ( S)-3-(3-(3,5-Dimethyl-1 H-pyrazol-1-yl)phenyl)-4-(( R)-3-(2-(5,6,7,8-tetrahydro-1,8-naphthyridin-2-yl)ethyl)pyrrolidin-1-yl)butanoic Acid, a Nonpeptidic α vβ 6 Integrin Inhibitor for the Inhaled Treatment of Idiopathic Pulmonary Fibrosis. J Med Chem 2018; 61:8417-8443. [PMID: 30215258 DOI: 10.1021/acs.jmedchem.8b00959] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A series of 3-aryl(pyrrolidin-1-yl)butanoic acids were synthesized using a diastereoselective route, via a rhodium catalyzed asymmetric 1,4-addition of arylboronic acids in the presence of ( R)-BINAP to a crotonate ester to provide the ( S) absolute configuration for the major product. A variety of aryl substituents including morpholine, pyrazole, triazole, imidazole, and cyclic ether were screened in cell adhesion assays for affinity against αvβ1, αvβ3, αvβ5, αvβ6, and αvβ8 integrins. Numerous analogs with high affinity and selectivity for the αvβ6 integrin were identified. The analog ( S)-3-(3-(3,5-dimethyl-1 H-pyrazol-1-yl)phenyl)-4-(( R)-3-(2-(5,6,7,8-tetrahydro-1,8-naphthyridin-2-yl)ethyl)pyrrolidin-1-yl)butanoic acid hydrochloride salt was found to have very high affinity for αvβ6 integrin in a radioligand binding assay (p Ki = 11), a long dissociation half-life (7 h), very high solubility in saline at pH 7 (>71 mg/mL), and pharmacokinetic properties commensurate with inhaled dosing by nebulization. It was selected for further clinical investigation as a potential therapeutic agent for the treatment of idiopathic pulmonary fibrosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Colin J Suckling
- Department of Pure & Applied Chemistry , University of Strathclyde , 295 Cathedral Street , Glasgow G1 1XL , Scotland, U.K
| | | | | | | |
Collapse
|
32
|
Bardsley G, Daley-Yates P, Baines A, Kempsford R, Williams M, Mallon T, Braithwaite I, Riddell K, Joshi S, Bareille P, Beasley R, Fingleton J. Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: a cross-over randomised controlled trial. Respir Res 2018; 19:133. [PMID: 30001712 PMCID: PMC6044077 DOI: 10.1186/s12931-018-0836-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Fluticasone furoate/Vilanterol trifenatate (FF/VI) is an inhaled corticosteroid/long-acting beta-agonist combination with a prolonged bronchodilator duration of action. We characterised the time-course of onset and offset of airway anti-inflammatory action of FF/VI, as assessed by fraction of exhaled nitric oxide (FeNO), and compared this to the bronchodilator duration of action. METHODS A single-centre, randomised, double-blind, placebo-controlled, two-period, crossover study was undertaken in 28 steroid-naïve adults with asthma. Participants with an FEV1 ≥ 60% predicted, reversible airway disease, and FeNO > 40 ppb received FF/VI 100/25 mcg or placebo once daily for 14 days. FeNO and peak expiratory flow were measured twice-daily during treatment and during a 21-day washout period. FEV1 was measured for five days from treatment cessation. The primary outcome measure was FeNO change from baseline ratio for 21 days following treatment cessation. RESULTS In the 27 subjects who completed the study, median (range) baseline FeNO was 87 ppb (42-212). FF/VI 100/25 mcg reduced FeNO by day 3, ratio FF/VI versus placebo 0.72 (95% confidence interval 0.61-0.86) with the maximum reduction occurring at day 14, 0.32 (0.27-0.37). Following cessation of treatment FeNO remained suppressed for 18 days, ratio on day 18 0.77 (0.59-1.00), whereas improvements in FEV1 and peak flow were maintained for 3 to 4 days post-treatment. CONCLUSIONS The anti-inflammatory duration of action of FF/VI is consistent with the high glucocorticoid receptor affinity and long lung retention of fluticasone furoate. The anti-inflammatory effect of FF/VI was of greater duration than its bronchodilator effect in adults with mild asthma. Funding GlaxoSmithKline (201499). TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov registry number NCT02712047 .
Collapse
Affiliation(s)
- George Bardsley
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Peter Daley-Yates
- Respiratory Clinical Development, GlaxoSmithKline Research and Development, Stockley Park, Uxbridge, UK
| | - Amanda Baines
- Medicines Development Centre, GlaxoSmithKline Research and Development, Stevenage, UK
| | - Rodger Kempsford
- Medicines Development Centre, GlaxoSmithKline Research and Development, Stevenage, UK
| | - Mathew Williams
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Tony Mallon
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - Kylie Riddell
- GlaxoSmithKline Research and Development, 82 Hughes Ave, Ermington, NSW, 2115, Australia
| | | | - Philippe Bareille
- Medicines Development Centre, GlaxoSmithKline Research and Development, Stevenage, UK
| | - Richard Beasley
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Private Bag 7902, Newtown, Wellington, 6242, New Zealand.
| |
Collapse
|
33
|
Strong P, Ito K, Murray J, Rapeport G. Current approaches to the discovery of novel inhaled medicines. Drug Discov Today 2018; 23:1705-1717. [PMID: 29775668 DOI: 10.1016/j.drudis.2018.05.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/11/2018] [Accepted: 05/10/2018] [Indexed: 01/16/2023]
Abstract
Inhaled administration is underutilised because the drug discovery process is viewed as challenging, risky, and expensive. However, unmet medical need continues to grow, and significant opportunities exist to discover novel inhaled medicines delivering the required lung concentrations while minimising systemic exposure. This profile could be achieved by a combination of properties, including lung retention and low oral bioavailability. Property-based rules exist for orally administered compounds, but there has been limited progress defining in silico predictors to guide the discovery of novel inhaled drugs. Recently, the use of informative cell- and tissue-based screens has greatly facilitated the identification of compounds with optimal characteristics for inhaled delivery. Here, we address opportunities for novel inhaled drugs, and the key challenges and uncertainties hampering progress.
Collapse
Affiliation(s)
- Peter Strong
- Pulmocide Ltd, 52 Princes Gate, Exhibition Road, London SW7 2 PG, UK
| | - Kazuhiro Ito
- Pulmocide Ltd, 52 Princes Gate, Exhibition Road, London SW7 2 PG, UK
| | - John Murray
- Pulmocide Ltd, 52 Princes Gate, Exhibition Road, London SW7 2 PG, UK
| | - Garth Rapeport
- Pulmocide Ltd, 52 Princes Gate, Exhibition Road, London SW7 2 PG, UK.
| |
Collapse
|
34
|
Song JU, Park HK, Lee J. Impact of dosage timing of once-daily inhaled corticosteroids in asthma: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2018; 120:512-519. [PMID: 29573961 DOI: 10.1016/j.anai.2017.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/14/2017] [Accepted: 12/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Once-daily inhaled corticosteroids (ICSs) are widely used as first-line therapy in patients with asthma. OBJECTIVE To compare the efficacy of ICSs administered once daily in the morning or evening as determined by lung function. METHODS Medline, Embase, and the Cochrane Central Register were searched for relevant clinical trials. The primary outcome was lung function assessed as trough forced expiratory volume in 1 second and peak expiratory flow at end point. RESULTS Eight randomized clinical trials involving 1,234 patients were analyzed. The total number of patients treated with once-daily ICS in the morning and evening was 628 and 606, respectively. Pooled estimates showed that ICS administered once daily in the evening resulted in mild improvements in trough forced expiratory volume in 1 second (mean difference 0.05 L; 95% confidence interval 0.01-0.09; P = .026; I2 = 22.5%) and morning peak expiratory flow (mean difference 13.92 L/min; 95% confidence interval 5.77-22.06; P = .001; I2 = 13%) at end point compared with morning dosing. The change in use of rescue medicine and the incidence of adverse events with once-daily ICS were not significantly different between the 2 dosing times. CONCLUSION Compared with morning dosing, ICSs administered once daily in the evening seemed to provide some benefits in lung function for patients with asthma. However, because of methodologic limitations, further large-scale randomized clinical trials for dosing time of once-daily ICSs are needed.
Collapse
Affiliation(s)
- Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea
| | - Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju-si, Republic of Korea.
| |
Collapse
|
35
|
Lipworth BJ, Jabbal S. FULFIL an Unmet Need in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 196:1082. [PMID: 28534640 DOI: 10.1164/rccm.201704-0728le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Brian J Lipworth
- 1 Scottish Centre for Respiratory Research Dundee, Scotland, United Kingdom
| | - Sunny Jabbal
- 1 Scottish Centre for Respiratory Research Dundee, Scotland, United Kingdom
| |
Collapse
|
36
|
Janson C, Stratelis G, Miller-Larsson A, Harrison TW, Larsson K. Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:3055-3064. [PMID: 29089754 PMCID: PMC5654780 DOI: 10.2147/copd.s143656] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Inhaled corticosteroids (ICSs) treatment combined with long-acting β2-adrenoceptor agonists (LABAs) reduces the risk of exacerbations in COPD, but the use of ICSs is associated with increased incidence of pneumonia. There are indications that this association is stronger for fluticasone propionate than for budesonide. We have examined systematic reviews assessing the risk of pneumonia associated with fluticasone propionate and budesonide COPD therapy. Compared with placebo or LABAs, we found that fluticasone propionate was associated with 43%-78% increased risk of pneumonia, while only slightly increased risk or no risk was found for budesonide. We have evaluated conceivable mechanisms which may explain this difference and suggest that the higher pneumonia risk with fluticasone propionate treatment is caused by greater and more protracted immunosuppressive effects locally in the airways/lungs. These effects are due to the much slower dissolution of fluticasone propionate particles in airway luminal fluid, resulting in a slower uptake into the airway tissue and a much longer presence of fluticasone propionate in airway epithelial lining fluid.
Collapse
Affiliation(s)
- Christer Janson
- Respiratory, Allergy and Sleep Research Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Georgios Stratelis
- Respiratory, Allergy and Sleep Research Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Respiratory, Inflammation and Autoimmunity, AstraZeneca Nordic, Södertälje, Sweden
| | | | - Tim W Harrison
- Nottingham Respiratory Research Unit, City Hospital Campus, University of Nottingham, Nottingham, UK
| | - Kjell Larsson
- Lung and Airway Research, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
37
|
Bhagwat S, Schilling U, Chen MJ, Wei X, Delvadia R, Absar M, Saluja B, Hochhaus G. Predicting Pulmonary Pharmacokinetics from In Vitro Properties of Dry Powder Inhalers. Pharm Res 2017; 34:2541-2556. [DOI: 10.1007/s11095-017-2235-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
|
38
|
Melin J, Prothon S, Kloft C, Cleton A, Amilon C, Jorup C, Bäckman P, Olsson B, Hamrén UW. Pharmacokinetics of the Inhaled Selective Glucocorticoid Receptor Modulator AZD5423 Following Inhalation Using Different Devices. AAPS JOURNAL 2017; 19:865-874. [PMID: 28281196 DOI: 10.1208/s12248-016-0042-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/30/2016] [Indexed: 11/30/2022]
Abstract
AZD5423 is a non-steroidal glucocorticoid receptor modulator, with low aqueous solubility, developed for treatment of asthma and COPD. In this work, we aim to evaluate and compare the absorption pharmacokinetics (PK) of AZD5423 after inhalation via four devices, (Spira®, I-neb®, Turbuhaler® and a new dry powder inhaler (new DPI)) with two formulations using differently sized primary particles, and to compare the pulmonary bioavailability with the predicted lung deposited dose. Plasma concentration-time data after intravenous, oral and inhaled administration via four devices were available from two clinical studies in healthy and asthmatic subjects. A population PK modelling approach was taken to sequentially incorporate each route of administration, assuming parallel absorption compartments for inhaled AZD5423. A non-compartmental analysis for derivation of PK parameters was performed for comparison. Pulmonary bioavailability varied between devices, with the lowest estimates for I-neb (27%) and Turbuhaler (30%) and the highest for the new DPI (46%) and Spira (35-49%). The pulmonary bioavailability was substantially lower than the predicted lung deposited dose (range 59-90%). Lung absorption was separated into a faster and a slower process in the model. The half-life of the faster absorption appeared formulation-dependent, while the slower absorption (half-life of 0.59-0.78 h) appeared independent of formulation. The large difference in the estimated pulmonary bioavailability and the predicted lung deposited dose for AZD5423 implies an impact of mucociliary clearance. The lung absorption half-life indicates that AZD5423 is retained in the lung for a relatively short time.
Collapse
Affiliation(s)
- Johanna Melin
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany.,Graduate Research Training program PharMetrX, Berlin, Germany.,Quantitative Clinical Pharmacology, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Susanne Prothon
- Quantitative Clinical Pharmacology, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Adriaan Cleton
- Clinical Sciences, Bayer Healthcare Pharmaceuticals, Berlin, Germany
| | - Carl Amilon
- Quantitative Clinical Pharmacology, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Carin Jorup
- AstraZeneca Global Medicines development, Gothenburg, Sweden
| | - Per Bäckman
- Mylan Global Respiratory Group, Sandwich, UK
| | - Bo Olsson
- Quantitative Clinical Pharmacology, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden.,Emmace Consulting AB, Lund, Sweden
| | - Ulrika Wählby Hamrén
- Quantitative Clinical Pharmacology, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden. .,AstraZeneca, Pepparedsleden 1, Mölndal, 431 83, Sweden.
| |
Collapse
|
39
|
Albertson TE, Bullick SW, Schivo M, Sutter ME. Spotlight on fluticasone furoate/vilanterol trifenatate for the once-daily treatment of asthma: design, development and place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:4047-4060. [PMID: 28008228 PMCID: PMC5167476 DOI: 10.2147/dddt.s113573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The use of inhaled corticosteroids (ICSs) plays a key role in the treatment of asthmatic patients, and international guidelines have designated ICSs as an early maintenance therapy in controlling asthma symptoms. When asthmatic patients remain symptomatic on ICSs, one common option is to add a long-acting beta2 agonist (LABA) to the maintenance treatment. Fixed combination inhalers that contain both an ICS and a LABA have been popular for both chronic obstructive pulmonary disease (COPD) and asthma. Historically, these inhalers have been dosed twice daily. However, currently, there is a once-daily combination therapy with the ICS fluticasone furoate (FF) and the LABA vilanterol trifenatate (VI) with indications for use in both COPD and asthma. This dry powder inhaler (DPI) comes in two doses of FF (100 or 200 μg) both combined with VI (25 μg). This article reviews the clinical trial data for FF, VI and FF/VI combination inhalers and documents the efficacy and safety of once-daily inhaled maintenance therapy by DPI in asthmatic patients.
Collapse
Affiliation(s)
- Timothy E Albertson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine; Department of Emergency Medicine, School of Medicine, UC Davis, Sacramento; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA, USA
| | - Samuel W Bullick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA, USA
| | - Michael Schivo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine
| | - Mark E Sutter
- Department of Emergency Medicine, School of Medicine, UC Davis, Sacramento; Department of Medicine, Veterans Administration Northern California Health Care System, Mather, CA, USA
| |
Collapse
|
40
|
O’Byrne PM, Jacques L, Goldfrad C, Kwon N, Perrio M, Yates LJ, Busse WW. Integrated safety and efficacy analysis of once-daily fluticasone furoate for the treatment of asthma. Respir Res 2016; 17:157. [PMID: 27881132 PMCID: PMC5122018 DOI: 10.1186/s12931-016-0473-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fluticasone furoate is a once-daily inhaled corticosteroid. This report provides an overview of safety and efficacy data that support the use of once-daily fluticasone furoate 100 μg or 200 μg in adult and adolescent asthma patients. METHODS Fourteen clinical studies (six Phase II and eight Phase III) were conducted as part of the fluticasone furoate global clinical development programme in asthma. Safety data from 10 parallel-group, randomised, double-blind Phase II and III studies (including 3345 patients who received at least one dose of fluticasone furoate) were integrated to provide information on adverse events, withdrawals, laboratory assessments, vital signs and hypothalamic-pituitary-adrenal axis function. The efficacy of once-daily fluticasone furoate was evaluated in all included studies. RESULTS Once-daily fluticasone furoate 100 μg and 200 μg safety profiles were consistent with those reported for other inhaled corticosteroids, and both doses consistently demonstrated efficacy versus placebo. In the integrated analysis, no dose-response relationship was observed for the overall incidence of adverse events and there were no significant effects of fluticasone furoate on hypothalamic-pituitary-adrenal axis function. CONCLUSION Once-daily fluticasone furoate 100 μg and 200 μg had acceptable safety profiles and was efficacious in adult and adolescent patients with asthma. There was no evidence of cortisol suppression at studied doses. TRIAL REGISTRATIONS GSK (NCT01499446/FFA20001, NCT00398645/FFA106783, NCT00766090/112202, NCT00603746/FFA109684, NCT00603278/FFA109685, NCT00603382/FFA109687, NCT01436071/115283, NCT01436110/115285, NCT01159912/112059, NCT01431950/114496, NCT01165138/HZA106827, NCT01086384/106837, NCT01134042/HZA106829 and NCT01244984/1139879).
Collapse
Affiliation(s)
- Paul M. O’Byrne
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON Canada
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Room 3W10, Hamilton, ON L8S 4K1 Canada
| | - Loretta Jacques
- Respiratory Medicine Development Centre, GSK, London, TW8 9GS UK
| | | | - Namhee Kwon
- Respiratory Franchise Medical, GSK, London, TW8 9GS UK
| | - Michael Perrio
- Global Clinical Safety and Pharmacovigilance, GSK, TW8 9GS London, UK
| | | | - William W. Busse
- University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| |
Collapse
|
41
|
Chang V, Gray EL, Thomas PS. Phamacology of fluticasone furoate and vilanterol trifenatate combination therapy for asthma. Expert Rev Respir Med 2016; 10:1069-78. [PMID: 27599692 DOI: 10.1080/17476348.2016.1227245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fluticasone furoate (FF) is a novel inhaled corticosteroid (ICS). Vilanterol trifenate (VI) is a new inhaled, selective, long - acting β2 adrenergic agonist (LABA). It is now also marketed as a novel once daily combined ICS/LABA indicated for treatment of moderate and severe asthma. AREAS COVERED FF has a highly specific, fast association and slow dissociation from the glucocorticoid receptor, with a 24 hr duration of action. This, combined with a slow transport out of respiratory cells, creates a long tissue retention period. Vilanterol trifenate (VI) is a new inhaled, selective, long - acting β2 adrenergic agonist, also with a rapid onset of action with a maximal effect within 6 mins and prolonged lung retention with effects on lung function over 24 hours. Expert commentary: Multiple Phase I-III efficacy studies performed on FF and VI have shown an improvement in spirometry as well as symptom control in asthma. The development of once daily ICS/LABA combinations may potentially improve adherence to asthma therapy, but this has yet to be demonstrated.
Collapse
Affiliation(s)
- Vicky Chang
- a Department of Respiratory Medicine , Prince of Wales Hospital , Randwick , Australia
| | - Emma L Gray
- a Department of Respiratory Medicine , Prince of Wales Hospital , Randwick , Australia
| | - Paul S Thomas
- a Department of Respiratory Medicine , Prince of Wales Hospital , Randwick , Australia.,b Inflammation and Infection Research Centre, School of Medical Sciences, and Prince of Wales Clinical School , University of New South Wales , Randwick , Australia
| |
Collapse
|
42
|
Maternal inhaled fluticasone propionate intake during pregnancy is detected in neonatal cord blood. Bioanalysis 2016; 8:1441-1450. [PMID: 27349687 DOI: 10.4155/bio-2016-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite recommendations to use inhaled corticosteroids as treatment to control asthma during pregnancy, it is unknown whether inhaled fluticasone propionate (FP) reaches the fetus. Results & methodology: We collected maternal blood on the morning following delivery. FP was detected by ultra-performance LC-MS/MS (UPLC-MS/MS) in 9/17 asthmatic women using FP. Delay between last FP inhalation and maternal blood sampling ranged between 3 and 33 h and FP was detected in a range of 1.572-46.440 pg/ml. Among the nine offspring of these FP users, FP was detected in five cord blood samples. Delay between last predelivery FP inhalation and cord blood sampling ranged from 4 to 20 h and FP was detected in a range of 0.423-4.510 pg/ml. CONCLUSION Our findings demonstrate placental passage of inhaled FP.
Collapse
|
43
|
Calzetta L, Rinaldi B, Cazzola M, Matera MG. Pharmacodynamic and pharmacokinetic assessment of fluticasone furoate + vilanterol for the treatment of asthma. Expert Opin Drug Metab Toxicol 2016; 12:813-22. [PMID: 27253498 DOI: 10.1080/17425255.2016.1192125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The pharmacokinetic (PK) and pharmacodynamic (PD) effects of long-acting β2-agonists and mostly inhaled corticosteroids (ICSs) shape the efficacy and safety of these agents in the treatment of asthma. In fact, the PK and PD characteristics of the drug largely determine the degree of pulmonary targeting Areas covered. In this review, we summarize the PK and PD properties of inhaled fluticasone furoate (FF) and vilanterol trifenatate (VI) and their fixed-dose combination (FDC) for the treatment of asthma Expert opinion. It is difficult to interpret the data that we have described because the preclinical and clinical development of FF/VI FDC was not really based on solid information on quantitative PK/PD approach. Unfortunately, for both FF and VI we only know concentrations in systemic blood, a compartment that is downstream of both target and non-target respiratory tissue. This lack of information does not allow us to understand the temporal relationship between the delivered dose and the drug concentration at the sites of action within the lungs. In addition, all studies performed with FF and VI did not address the fundamental issue that asthma can significantly alter lung deposition, absorption and also clearance of inhaled medicines.
Collapse
Affiliation(s)
- Luigino Calzetta
- a Department of Systems Medicine, Unit of Respiratory Clinical Pharmacology , University of Rome Tor Vergata , Roma , Italy
| | - Barbara Rinaldi
- b Department of Experimental Medicine, Section of Pharmacology 'L. Donatelli', Centre of Excellence for Cardiovascular Diseases , Second University of Naples , Naples , Italy
| | - Mario Cazzola
- a Department of Systems Medicine, Unit of Respiratory Clinical Pharmacology , University of Rome Tor Vergata , Roma , Italy
| | - Maria Gabriella Matera
- b Department of Experimental Medicine, Section of Pharmacology 'L. Donatelli', Centre of Excellence for Cardiovascular Diseases , Second University of Naples , Naples , Italy
| |
Collapse
|
44
|
Rodrigo GJ, Plaza V. Once-daily fluticasone furoate and vilanterol for adolescents and adults with symptomatic asthma: A systematic review with meta-analysis. Ann Allergy Asthma Immunol 2016; 116:565-70. [PMID: 27117053 DOI: 10.1016/j.anai.2016.03.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/02/2016] [Accepted: 03/31/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fluticasone furoate and vilanterol is a new inhaled corticosteroid (ICS) and long-acting β2-agonist (LABA) combination developed for once-daily administration via a dry powder inhaler. OBJECTIVE To assess the efficacy and safety of fluticasone furoate-vilanterol in adolescents and adults with symptomatic asthma compared with ICS monotherapy or twice-daily ICS-LABA formulations. METHODS Randomized, placebo-controlled trials with longer than 8 weeks of treatment duration were included. Primary outcome was pulmonary function (forced expiratory volume in 1 second [FEV1] or peak expiratory flow rate [PEF]). RESULTS Seven published randomized clinical trials were included (5,668 patients). Fluticasone furoate-vilanterol was associated with significant increases in trough FEV1 and morning and evening PEF compared with fluticasone furoate, 100 μg, monotherapy (90 mL, 20.1 L/min, and 18.9 L/min respectively). Fluticasone furoate-vilanterol reduced significantly the rate of severe asthma exacerbations (number need to treat for benefit = 24). Fluticasone furoate-vilanterol also produced significant increases in weighted FEV1 and morning and evening PEF (140 mL, 32.6 L/min, and 25.7 L/min, respectively) compared with fluticasone propionate, 500 μg twice daily. Fluticasone furoate-vilanterol presented a nonsignificant increase in the frequency of cardiac events (6.4% vs 1.8%) compared with fluticasone propionate. No differences were found between both available doses of fluticasone furoate-vilanterol (200/25 μg and 100/25 μg) in terms of efficacy. However, patients receiving fluticasone furoate-vilanterol, 200/25 μg, had a trend toward an increased risk of cardiac events. CONCLUSION Fluticasone furoate-vilanterol combination was associated with an increase in trough FEV1 compared with fluticasone furoate-fluticasone propionate; however, observed differences may not be clinically significant. Studies comparing fluticasone furoate-vilanterol with fixed twice-daily ICS-LABA combinations are required.
Collapse
Affiliation(s)
- Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, and Department of Medicine, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
45
|
Chantaphakul H, Ruxrungtham K. Fixed-Dose combination of the inhaled corticosteroid and long-acting beta2-agonist therapy in adults with persistent asthma. Expert Opin Pharmacother 2016; 17:631-42. [PMID: 26799114 DOI: 10.1517/14656566.2016.1145659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Asthma is a respiratory condition characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. The standard treatment of asthma comprises inhaled corticosteroid and beta2-agonist. Inhaled short-acting-beta2-agonists have been used as rescue medication for exacerbation. However, long-acting-beta2-agonists (LABA) used as monotherapy for asthma had been reported for having a safety concern. Consequently, it had been recommended as an add-on treatment to inhaled corticosteroid (ICS) in moderate to severe persistent asthma. The fixed-dose combination (FDC) of ICS and LABA has been approved since the year 2000. Evidences revealed using the combination of these medications is more effective in asthma control. AREAS COVERED The rational and phase III onward randomized-controlled studies were reviewed. Sources of evidences were from studies published in Medline until November 2015. EXPERT OPINION There are six FDC inhaler regimens approved worldwide. The significant synergistic effects of ICS and LABA in one device are well evidenced. A FDC reduces the daily dosage of ICS and asthma exacerbation. It is safe to use regularly as controller. The efficacy of each individual combination on asthma treatment is generally similar. Clinical experience, ease of use, cost and side effects of medication would guide the clinician's preferences.
Collapse
Affiliation(s)
- Hiroshi Chantaphakul
- a Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| | - Kiat Ruxrungtham
- a Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand
| |
Collapse
|
46
|
Albertson TE, Richards JR, Zeki AA. The combination of fluticasone furoate and vilanterol trifenatate in the management of asthma: clinical trial evidence and experience. Ther Adv Respir Dis 2016; 10:43-56. [PMID: 26668137 PMCID: PMC5933662 DOI: 10.1177/1753465815619136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of persistent asthma has been aided by the recent approval of new medications. The combined inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) powder inhaler fluticasone furoate (FF)/vilanterol trifenatate (VI) is one of these new agents, which was recently approved as a maintenance therapy for persistent asthma. This once-daily ICS/LABA inhaler has previously been approved and used in chronic obstructive pulmonary disease as a maintenance therapy. Both FF and VI individually have been shown to have efficacy in the treatment of persistent asthma; the combination of FF/VI at the dose of 100/25 μg daily improves trough peak expiratory flows and forced expiratory volume in 1 s. It also reduces the frequency of asthma exacerbations in patients with persistent asthma. The once-daily dosing is well tolerated, with limited clinically significant adverse events; the once-daily inhaled dosing regimen should also improve medication adherence. The data supporting the use of the FF/VI inhaler in persistent asthma are reviewed. The dry powder inhaler of FF/VI (100/25 μg) is an effective and well tolerated once-daily maintenance treatment for patients with persistent asthma.
Collapse
Affiliation(s)
- Timothy E Albertson
- Division of Pulmonary, Critical Care Medicine, Department of Internal Medicine and VA Northern California Healthcare Center, Mather UC Davis School of Medicine, 4150 V Street, Suite 3100, Sacramento, CA 95817, USA
| | - John R Richards
- Department Emergency Medicine, University of California, Davis, Sacramento, CA, USA
| | - Amir A Zeki
- Division of Pulmonary, Critical Care and Sleep Medicine University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
47
|
Kempsford RD, Bal J, Baines A, Renaux J, Ravindranath R, Thomas PS. The efficacy of fluticasone furoate administered in the morning or evening is comparable in patients with persistent asthma. Respir Med 2016; 112:18-24. [PMID: 26823210 DOI: 10.1016/j.rmed.2015.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/09/2015] [Accepted: 12/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The inhaled corticosteroid fluticasone furoate (FF) is efficacious as a once-daily treatment for the management of asthma. Asthma is associated with circadian changes, with worsening lung function at night. We compared the efficacy of once-daily FF in the morning or evening for the treatment of asthma. METHODS Adults with persistent bronchial asthma were enrolled into this randomised, repeat-dose, double-blind, double-dummy, placebo-controlled, three-way crossover study. After a 14-day run-in period, patients received either: FF 100 μg in the morning (AM); FF 100 μg in the evening (PM); or placebo, via the ELLIPTA(®) dry powder inhaler. Patients received all three treatments (14 ± 2 day duration) separated by a 14- to 21-day washout period. The primary endpoint was 24-h weighted mean forced expiratory volume in 1 s (FEV1) measured at the end of each 14-day treatment. RESULTS A total of 28 patients aged between 19 and 67 years were randomised and 21 (75%) completed all three study arms. Once-daily administration of FF 100 μg resulted in an increased 24-hour weighted mean FEV1; differences between the adjusted means for AM and PM FF dosing versus placebo were 0.077 L (90% confidence interval [CI]: 0.001, 0.152) and 0.105 L (90% CI: 0.029, 0.180), respectively (adjusted mean difference: -0.028 L [90% CI: -0.102, 0.045]). AM or PM doses had comparable incidences of adverse events (AEs; 18/23 versus 18/24, respectively), no serious AEs occurred. CONCLUSION AM and PM doses of once-daily FF 100 μg produced comparable improvements in lung function relative to placebo.
Collapse
Affiliation(s)
- R D Kempsford
- GSK R&D Medicines Research Centre, Stevenage, Hertfordshire, UK.
| | - J Bal
- GSK R&D Stockley Park West, Uxbridge, Middlesex, UK.
| | - A Baines
- GSK R&D Medicines Research Centre, Stevenage, Hertfordshire, UK.
| | - J Renaux
- GSK R&D Stockley Park West, Uxbridge, Middlesex, UK.
| | | | - P S Thomas
- Prince of Wales Hospital Clinical School, University of New South Wales, and Respiratory Medicine, Prince of Wales Hospital, New South Wales, Australia.
| |
Collapse
|
48
|
Syed YY. Fluticasone furoate/vilanterol: a review of its use in patients with asthma. Drugs 2016; 75:407-18. [PMID: 25648266 DOI: 10.1007/s40265-015-0354-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fluticasone furoate/vilanterol (Relvar(®)) is a once-daily, fixed combination of an inhaled corticosteroid (ICS) and a long-acting β2-adrenoreceptor agonist (LABA), delivered via a dry powder inhaler (Ellipta(®)). It is approved for the treatment of asthma in the EU and Japan, and is the first once-daily ICS/LABA to be available for this indication. Fluticasone furoate is an enhanced-affinity glucocorticoid receptor agonist, with potent anti-inflammatory activity. Vilanterol produces rapid and prolonged bronchodilation. In phase III trials in adolescents and adults with various levels of asthma uncontrolled on ICS and/or ICS/LABA, fluticasone furoate/vilanterol 100/25 or 200/25 µg once daily (approved dosages in the EU) significantly improved pulmonary function compared with placebo or equivalent dosages of fluticasone furoate alone (in some trials) or fluticasone propionate. In similar trials, fluticasone furoate/vilanterol 100/25 µg once daily was as effective as fluticasone propionate/salmeterol 250/50 µg twice daily in improving pulmonary function and significantly reduced the risk of severe asthma exacerbation relative to fluticasone furoate alone. In clinical trials, fluticasone furoate/vilanterol was generally well tolerated with fewer than 15 % of patients experiencing treatment-related adverse events, the most common of which were oral/oropharyngeal candidiasis, dysphonia, extrasystoles and cough. The tolerability profile of fluticasone furoate/vilanterol was generally similar to that of fluticasone propionate/salmeterol. Thus, fluticasone furoate/vilanterol is an effective and generally well tolerated ICS/LABA option for the treatment of uncontrolled asthma.
Collapse
Affiliation(s)
- Yahiya Y Syed
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
| |
Collapse
|
49
|
Bollmeier SG, Prosser TR. Patient perspectives on fluticasone-vilanterol versus other corticosteroid combination products for the treatment of asthma. Patient Prefer Adherence 2016; 10:825-36. [PMID: 27257375 PMCID: PMC4874727 DOI: 10.2147/ppa.s83946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Fluticasone furoate (FF), an inhaled corticosteroid (ICS), and vilanterol (VI), a long-acting beta2 receptor agonist (LABA), is a new combination used in an Ellipta(®) device. This article compares FF-VI to other ICS-LABA combinations available, particularly emphasizing product selection from the patient perspective. DATA SOURCES A PubMED and EMBASE search completed in October 2015 identified trials using the MeSH terms "fluticasone", "vilanterol", and "asthma". Additional information was gathered from references cited in the identified publications, the manufacturer, package insert, and ClinicalTrials.gov registry. STUDY SELECTION/DATA EXTRACTION Preference was given to randomized controlled clinical trials. Animal trials, trials for COPD, and non-English sources were excluded. DATA SYNTHESIS Seven efficacy trials of FF-VI in asthma were identified. Only one (24 weeks) trial compared FF-VI to another ICS-LABA combination (fluticasone propionate-salmeterol). Primary outcomes (usually lung function) and secondary outcomes (eg, quality of life and symptom scores) were comparable. In three FF-VI safety trials, the type and frequency of common adverse reactions (ie, thrush and dysphonia) were similar to those in clinical trials. Over 90% of subjects rated the Ellipta(®) device as "easy to use" and demonstrated correct device technique initially and at 4 weeks. CONCLUSION Individuals may have drug- and device-specific preferences that should be incorporated into therapeutic decision making. Limited data indicate that clinical and patient-oriented efficacy/safety outcomes of FF-VI are likely comparable to other available combinations for adults with asthma. Patient-friendly features include once-daily dosing, flexibility of dose timing, and design/ease of the use of the device. Additional larger and long-term comparative studies are needed to determine whether these features translate into greater efficacy, safety, patient preference, or adherence versus other ICS-LABA combinations. In the next few years, the availability of less expensive generic ICS-LABA products may strongly influence patient preference.
Collapse
Affiliation(s)
- Suzanne G Bollmeier
- St Louis College of Pharmacy, St Louis, MO, USA
- Correspondence: Suzanne G Bollmeier, St Louis College of Pharmacy, 4588 Parkview Place, St Louis, MO 63110, USA, Tel +1 314 446 8525, Fax +1 314 446 8500, Email
| | | |
Collapse
|
50
|
Abstract
Glucocorticoids are the most effective treatment for asthma. However, their clinical applications are limited by low efficacy in severe asthma and by undesired side effects associated with high dose or prolonged use. The most successful approach to overcome these limitations has been the development of highly potent glucocorticoids that can be delivered to the lungs by inhalation to achieve local efficacy with minimal systemic effects. On the basis of our previous structural studies, we designed and developed a highly potent glucocorticoid, VSGC12, which showed an improved anti-inflammation activity in both cell-based reporter assays and cytokine inhibition experiments, as well as in a gene expression profiling of mouse macrophage RAW264.7 cells. In a mouse asthma model, VSGC12 delivered a higher efficacy than fluticasone furoate, a leading clinical compound, in many categories including histology and the number of differentiated immune cells. VSGC12 also showed a higher potency than fluticasone furoate in repressing most asthma symptoms. Finally, VSGC12 showed a better side effect profile than fluticasone furoate at their respective effective doses, including better insulin response and less bone loss in an animal model. The excellent therapeutic and side effect properties of VSGC12 provide a promising perspective for developing this potent glucocorticoid as a new effective drug for asthma.
Collapse
|