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Clegg JL, Souza CP, Sander WE. Long-lasting otic solution containing mometasone furoate can influence intradermal testing in dogs with healthy ears and otitis externa. Vet Dermatol 2024. [PMID: 39036951 DOI: 10.1111/vde.13281] [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: 03/23/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Topical therapy is preferred for otitis externa (OE) in dogs. Otic products commonly contain glucocorticoids that can be systemically absorbed and possibly interfere with diagnostic tests such as intradermal testing (IDT). HYPOTHESIS/OBJECTIVES To determine the effect of a long-lasting otic solution containing mometasone furoate (MF) on IDT immediate reactions and to determine withdrawal time before IDT. ANIMALS Seventeen dogs with healthy ears (Group 1) and 12 with OE (Group 2). MATERIALS AND METHODS Intradermal injections of histamine, anticanine-immunoglobulin (Ig)E and saline were subjectively and objectively evaluated before treatment and weekly for 6 weeks, after a single application of a long-lasting otic solution containing MF. RESULTS Statistically significant reductions in the mean subjective histamine scores after application of MF were observed at Weeks 1 (p = 0.012) and 2 (p = 0.028) in Group 1, and Weeks 1 (p = 0.00066), 2 (p = 0.02) and 4 (p = 0.034) in Group 2. Mean histamine objective scores were significantly reduced in Weeks 1 (p = 0.042), 2 (p = 0.0009), 3 (p = 0.001) and 5 (p = 0.018) in Group 1 only. The mean subjective anticanine-IgE scores were significantly reduced in Week 1 in both groups (p = 0.003, p = 0.0066), respectively. There were no significant changes in the mean anticanine-IgE objective score in either group. CONCLUSIONS AND CLINICAL RELEVANCE Application of a long-lasting otic solution containing MF can interfere with IDT immediate reactions in healthy and OE dogs. Based on the subjective evaluation, IDT can be performed ≥2 weeks after application of the otic solution in healthy dogs, and ≥4 weeks in dogs with OE.
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Affiliation(s)
- Jennifer L Clegg
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Clarissa P Souza
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - William E Sander
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
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2
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Heuer L, Wilhelm C, Roy O, Löhlein W, Wolf O, Zschiesche E. Clinical safety and efficacy of a single-dose gentamicin, posaconazole and mometasone furoate otic suspension for treatment of canine otitis externa. Vet Rec 2024; 194:e3955. [PMID: 38462781 DOI: 10.1002/vetr.3955] [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: 10/19/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND A single-dose, in-clinic, veterinary professional-administered treatment for canine otitis externa was developed to improve compliance and canine welfare. METHODS This multicentre, controlled, examiner-masked, randomised field trial was conducted in 316 dogs over 42 days. Dogs were treated once, on day 0, with the investigational product containing gentamicin, posaconazole and mometasone furoate (Mometamax Ultra [MU]) or twice (days 0 and 7) with a control product containing florfenicol, terbinafine and betamethasone acetate (CP). The primary endpoint was a composite otitis index score of 4 or less (of 12) on day 14 and 3 or less (of 12) on day 28. RESULTS On day 28, treatment success was recorded in 128 of 143 MU-treated dogs (89.5%), significantly non-inferior to 116 of 133 (87.2%) CP-treated dogs (Farrington-Manning test, Z = 4.1351, p < 0.0001). For mixed cultures of Staphylococcus pseudintermedius and Malassezia pachydermatis, there was 100% treatment success in MU-treated dogs (n = 33), significantly non-inferior to 90.2% (37 of 41) in CP-treated dogs (Farrington-Manning test, Z = 3.1954, p = 0.0007). LIMITATIONS Efficacy in chronic otitis externa cases was not investigated. Cytology was not used to aid in diagnosis or for identification of secondary pathogens. CONCLUSION This unique combination, single-dose product is safe and effective in dogs with otitis externa. It offers enhanced compliance, canine welfare and quality of life by eliminating the owner burden of treating this painful condition.
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Affiliation(s)
- Lea Heuer
- MSD Animal Health Innovation, Schwabenheim an der Selz, Germany
| | | | | | | | - Oliver Wolf
- Löhlein & Wolf Vet Research and Consulting, München, Germany
| | - Eva Zschiesche
- MSD Animal Health Innovation, Schwabenheim an der Selz, Germany
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3
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Amini E, Berger SM, Schilling U, Jiao Y, Chen MJ, Bachhav S, Baumstein SM, Tang Y, Al-Humiari M, Leon Astudillo CE, Drescher S, Iley T, Shur J, Price R, Carrasco C, Conti DS, Delvadia R, Oguntimein O, Witzmann K, Absar M, Luke MC, Boc S, Dhapare S, Saluja B, Bielski E, Newman B, Bulitta JB, Hochhaus G. Sensitivity of Pharmacokinetics to Differences in the Particle Size Distribution for Formulations of Locally Acting Mometasone Furoate Suspension-Based Nasal Sprays. Mol Pharm 2023; 20:5690-5700. [PMID: 37773975 DOI: 10.1021/acs.molpharmaceut.3c00553] [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: 10/01/2023]
Abstract
To assess bioequivalence of locally acting suspension-based nasal sprays, the U.S. FDA currently recommends a weight-of-evidence approach. In addition to in vitro and human pharmacokinetic (PK) studies, this includes a comparative clinical endpoint study to ensure equivalent bioavailability of the active pharmaceutical ingredient (API) at the site of action. The present study aimed to assess, within an in vitro/in vivo correlation paradigm, whether PK studies and dissolution kinetics are sensitive to differences in drug particle size for a locally acting suspension-based nasal spray product. Two investigational suspension-based nasal formulations of mometasone furoate (MF-I and MF-II; delivered dose: 180 μg) differed in API particle size and were compared in a single-center, double-blind, single-dose, randomized, two-way crossover PK study in 44 healthy subjects with oral charcoal block. Morphology-directed Raman spectroscopy yielded volume median diameters of 3.17 μm for MF-I and 5.50 μm for MF-II, and dissolution studies showed that MF-II had a slower dissolution profile than MF-I. The formulation with larger API particles (MF-II) showed a 45% smaller Cmax and 45% smaller AUC0-inf compared to those of MF-I. Systemic bioavailability of MF-I (2.20%) and MF-II (1.18%) correlated well with the dissolution kinetics, with the faster dissolving formulation yielding the higher bioavailability. This agreement between pharmacokinetics and dissolution kinetics cross-validated both methods and supported their use in assessing potential differences in slowly dissolving suspension-based nasal spray products.
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Affiliation(s)
- Elham Amini
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Simon M Berger
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Uta Schilling
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Yuanyuan Jiao
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, Florida 32827, United States
| | - Mong-Jen Chen
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Sagar Bachhav
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Sandra M Baumstein
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, Florida 32827, United States
| | - Yufei Tang
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Mohammed Al-Humiari
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida 32610, United States
| | - Carmen E Leon Astudillo
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida 32610, United States
| | - Stefanie Drescher
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
| | - Teresa Iley
- Intertek Melbourn, Melbourn Herts SG8 6DN, UK
| | - Jagdeep Shur
- Nanopharm Ltd, an Aptar Pharma Company, Cavendish House, Newport, NP10 8FY, UK
| | - Robert Price
- Nanopharm Ltd, an Aptar Pharma Company, Cavendish House, Newport, NP10 8FY, UK
| | | | - Denise S Conti
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Renishkumar Delvadia
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Oluwamurewa Oguntimein
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Kimberly Witzmann
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Mohammad Absar
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Markham C Luke
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Susan Boc
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Sneha Dhapare
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Bhawana Saluja
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Elizabeth Bielski
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Bryan Newman
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Jürgen B Bulitta
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 6550 Sanger Road, Orlando, Florida 32827, United States
| | - Günther Hochhaus
- Department of Pharmaceutics, College of Pharmacy, University of Florida, 1345 Center Drive, Gainesville, Florida 32610, United States
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Lim L, Lipari M, Kale-Pradhan P. Intranasal Olopatadine: Mometasone in the Treatment of Seasonal Allergic Rhinitis. Ann Pharmacother 2022; 57:570-578. [PMID: 36123818 DOI: 10.1177/10600280221124230] [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: 11/16/2022] Open
Abstract
OBJECTIVE To review the pharmacology, efficacy, and safety of intranasal olopatadine hydrochloride-mometasone furoate (OM) combination in the treatment of seasonal allergic rhinitis (SAR). DATA SOURCES The PubMed database and ClinicalTrials.gov were searched using the following terms: mometasone + olopatadine, GSP301, mometasone furoate, and olopatadine hydrochloride. STUDY SELECTION AND DATA EXTRACTION Articles published in English between January 1987 and August 2022 related to pharmacology, safety, and clinical trials were assessed. DATA SYNTHESIS In 2 phase II clinical trials, twice-daily (BID) and once-daily (QDay) intranasal OM demonstrated significant improvements in reflective total nasal symptom score (rTNSS) (BID P < 0.001 and QDay P < 0.001) and instantaneous total nasal symptom score (iTNSS) (BID P < 0.001 and P < 0.0001; QDay P < 0.001 and P < 0.0001). In 2 phase III clinical trials, BID OM showed significant improvements in rTNSS vs. placebo (P < 0.001), olopatadine monotherapy (P = 0.03 and P = 0.003), and mometasone monotherapy (P = 0.02 and P = 0.059). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE OM is indicated for treatment of SAR symptoms. Caution with use must be considered for certain high-risk patients, existing tuberculosis; fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex. Due to its quick and sustained onset of action, OM may be an ideal agent for initial treatment of moderate-severe SAR for patients 12 years and older. CONCLUSION OM significantly improves SAR symptoms and is a viable treatment option in short-term SAR.
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Affiliation(s)
- Lauren Lim
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Melissa Lipari
- Ambulatory Care, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, and Ascension St. John Hospital and Medical Center, Detroit, MI, USA
| | - Pramodini Kale-Pradhan
- Infectious Diseases, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, and Ascension St. John Hospital, Detroit, MI, USA
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5
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Brülls M, Oag S, Karlsson CA, Lamm Bergström E. Same lung deposited dose in dog dosing a fine and coarse aerosol indicates no difference in intranasal filtration. Int J Pharm 2022; 624:121977. [DOI: 10.1016/j.ijpharm.2022.121977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
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Brown HJ, Batra PS, Eggerstedt M, Ganti A, Papagiannopoulos P, Tajudeen BA. The possibility of short-term hypothalamic-pituitary-adrenal axis suppression with high-volume, high-dose nasal mometasone irrigation in postsurgical patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2021; 12:249-256. [PMID: 34569177 DOI: 10.1002/alr.22894] [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: 03/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Medically refractory chronic rhinosinusitis (CRS) is often treated with functional endoscopic sinus surgery (FESS) and high-volume steroid nasal irrigation. While budesonide is the most common steroid irrigation for this indication, mometasone has a superior pharmacokinetic profile, which may allow dose escalation. The safety and efficacy of mometasone at higher concentrations than previously used in treating CRS have not been explored. METHODS Patients were recruited from a tertiary level clinic between June 2018 and December 2019. Inclusion criteria included adults (>18 years); CRS diagnosis; previous FESS; pre-treatment morning cortisol within normal range; minimum of twice daily high-volume sinonasal mometasone irrigations (total dose of 4 mg) for 12 weeks; and post-treatment morning cortisol measured within 2 weeks following the study period. Patients with potential for endogenous or exogenous disruption of the HPA axis were excluded. RESULTS 14 patients were enrolled in this prospective cohort study. In all but one patient, pre- and post-treatment morning cortisol levels were not significantly different and were within normal limits (6.7-25.4 μg/dL). Following an uninterrupted 12-week treatment course, no evidence of HPA axis suppression was found (P = 0.915). The single patient who was found to have a low (1.3 μg/dL) post-treatment morning serum cortisol level reportedly received an intraarticular steroid shot several days prior to the blood draw. She remained asymptomatic and her rechecked serum cortisol was within normal limits at 12.3 μg/dL. CONCLUSIONS High-volume 2 mg twice daily sinonasal mometasone irrigations did not cause HPA axis suppression in a representative sample of patients with refractory CRS post-FESS with normal baseline cortisol levels.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Pete S Batra
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Eggerstedt
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ashwin Ganti
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Peter Papagiannopoulos
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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7
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Rivelli GG, Perez AC, Silva PHR, Gomes ECDL, Moreira CPDS, Tamashiro E, Valera FCP, Anselmo-Lima WT, Pianetti GA, Silva-Cunha A. Biodegradable Electrospun Nanofibers: A New Approach For Rhinosinusitis Treatment. Eur J Pharm Sci 2021; 163:105852. [PMID: 33862240 DOI: 10.1016/j.ejps.2021.105852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022]
Abstract
Biodegradable polymeric nanofibers containing mometasone furoate can be a new approach to drug delivery to treat chronic rhinosinusitis, providing controlled steroid delivery to the sinonasal mucosa. This study aimed to develop biodegradable polymeric nanofibers and explore the safety of these fibers in an in vivo rabbit model. The nanofibers' development has been optimized using the Response Surface Methodology (RSM) obtained with Design of Experiments (DoE) with the best conditions related to the polymer concentration and proportion of solvents used in the electrospinning process. The nanofibers were prepared, operating as a determinant factor, the nanofiber formation and its diameter evaluated by Scanning Electron Microscopy (SEM). The ideal system obtained was assessed by SEM, thermogravimetric analysis (TGA), X-ray diffraction (XRD), differential scanning calorimetry (DSC), assay, and drug delivery by UHLPC validated method. The results showed that the drug is dispersed in the polymeric matrix, is stable, and showed sustained release kinetics in a bio-relevant nasal environment (Higuchi model kinetics). In vivo tests, the level of inflammation at the animals' mucosa which received the nanofiber with the mometasone furoate was lower than those that received the nanofibers without the drug (α = 0.05). Histopathology analysis showed that the polymeric nanofibers containing mometasone are safe when topically applied on the sinonasal mucosa, opening a new horizon in chronic rhinosinusitis treatment.
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Affiliation(s)
- Graziella Gomes Rivelli
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG. 31270-901, Brazil
| | - André Coura Perez
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP. 14049-900, Brazil
| | | | | | | | - Edwin Tamashiro
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP. 14049-900, Brazil
| | | | | | - Gérson Antônio Pianetti
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG. 31270-901, Brazil
| | - Armando Silva-Cunha
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, MG. 31270-901, Brazil.
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8
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Andrews CP, Mohar D, Salhi Y, Tantry SK. Efficacy and safety of twice-daily and once-daily olopatadine-mometasone combination nasal spray for seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2019; 124:171-178.e2. [PMID: 31734334 DOI: 10.1016/j.anai.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND GSP301 is an investigational fixed-dose combination nasal spray of olopatadine hydrochloride (antihistamine) and mometasone furoate (corticosteroid). OBJECTIVE To evaluate efficacy and safety of GSP301 in patients with seasonal AR (SAR). METHODS In this phase 2, double-blind, parallel-group study, patients (≥12 years of age) with SAR were equally randomized to twice-daily GSP301 (olopatadine 665 μg and mometasone 25 μg), once-daily GSP301 (olopatadine 665 μg and mometasone 50 μg), twice-daily or once-daily olopatadine monotherapy (665 μg), mometasone monotherapy (twice-daily 25 μg or once-daily 50 μg), or placebo for 14 days. The primary endpoint-mean change from baseline in morning and evening reflective Total Nasal Symptom Score (rTNSS)-was analyzed using analysis of covariance (ANCOVA; P < .05 = statistically significant). Average morning and evening 12-hour instantaneous TNSS (iTNSS), ocular symptoms, individual symptoms, onset of action, quality of life, and adverse events (AEs) were also assessed. RESULTS A total of 1111 patients were randomized. Twice-daily GSP301 provided statistically significant and clinically meaningful rTNSS improvements vs placebo (P < .001), twice-daily olopatadine (P = .049), and mometasone (P = .004). Similar significant improvements in iTNSS were observed with twice-daily GSP301 vs placebo (P < .001) and twice-daily mometasone (P = .007); improvements were not significant vs olopatadine (P = .058). Once-daily GSP301 provided significant rTNSS and iTNSS improvements vs placebo and once-daily olopatadine (P < .01, all) but improvements were not significant vs mometasone. Treatment-emergent AEs rates were 10.8%, 9.5%, and 8.2%, with twice-daily GSP301, once-daily GSP301, and placebo, respectively. CONCLUSION Twice-daily GSP301 treatment was efficacious and well tolerated, providing statistically significant and clinically meaningful improvements in rTNSS (primary endpoint) vs placebo and both monotherapies. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT02318303.
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Affiliation(s)
| | - Dale Mohar
- Kerrville Research Associates, Kerrville, Texas
| | - Yacine Salhi
- Glenmark Pharmaceuticals Inc, Paramus, New Jersey
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9
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Nguyen TT, Soma PS, Mascenik T, Lewis CA, Lee RE, Thorp BD, Zanation AM, Ebert CS, Senior BA, Randell SH, Ehrmann BM, Kimple AJ. Mometasone absorption in cultured airway epithelium. Int Forum Allergy Rhinol 2019; 9:1451-1455. [PMID: 31633879 DOI: 10.1002/alr.22441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Topical mometasone is frequently used as an intranasal spray, on drug-eluting stents, and compounded by specialty pharmacies as a sinus rinse. A typical sinus rinse contains 1.2 mg of mometasone dissolved in 240 mL of buffered saline and is flushed through the sinonasal cavity. The mometasone irrigation rapidly flows to the contralateral sinonasal cavity or the nasopharynx with a contact time on the order of 5 to 10 seconds. However, no information is available on the absorption rate of topical mometasone on the sinonasal surface. METHODS To determine the absorption characteristics of mometasone, we harvested nasal epithelium from 2 healthy donors and differentiated them into a mature ciliated epithelium on Millicell membranes. We applied mometasone to the apical surface for various time intervals and then rinsed off non-absorbed mometasone with phosphate-buffered saline. Millicell membranes with the adherent epithelial cells were then harvested and stored in guanidine hydrochloride for quantification using high-performance liquid chromatography-mass spectrometry. RESULTS Fifty percent of the maximal absorption occurred after an average of 38 minutes after application, and maximal absorption occurred after an average of 114 minutes. CONCLUSION Our data provide an estimate for rates of absorption of mometasone applied to the sinonasal cavity and suggest that the absorption rates poorly match contact time during saline lavage.
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Affiliation(s)
- Tuong T Nguyen
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul S Soma
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Teresa Mascenik
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catherine A Lewis
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rhianna E Lee
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian D Thorp
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam M Zanation
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Charles S Ebert
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brent A Senior
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott H Randell
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brandie M Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam J Kimple
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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10
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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: 8] [Impact Index Per Article: 1.6] [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.
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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.
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11
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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
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Gross GN, Berman G, Amar NJ, Caracta CF, Tantry SK. Efficacy and safety of olopatadine-mometasone combination nasal spray for the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2019; 122:630-638.e3. [PMID: 30910440 DOI: 10.1016/j.anai.2019.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND GSP301 nasal spray is a fixed-dose combination of olopatadine hydrochloride (antihistamine) and mometasone furoate (corticosteroid). OBJECTIVE To evaluate the efficacy and safety of GSP301 in patients with seasonal allergic rhinitis (SAR). METHODS In this double-blind study, eligible patients (≥12 years of age) with SAR were randomized 1:1:1:1 to twice-daily GSP301 (665 μg of olopatadine and 25 μg of mometasone), olopatadine (665 μg), mometasone (25 μg), or placebo for 14 days. The primary end point-mean change from baseline in average morning and evening 12-hour reflective Total Nasal Symptom Score (rTNSS)-was analyzed via a mixed-effect model repeated measures (P < .05 was considered to be statistically significant). Additional assessments included average morning and evening 12-hour instantaneous TNSS (iTNSS), ocular symptoms, individual symptoms, onset of action, quality of life, and adverse events (AEs). RESULTS A total of 1176 patients were randomized. GSP301 provided statistically significant and clinically meaningful rTNSS improvements vs placebo (least squares mean difference, -1.09; 95% CI, -1.49 to -0.69; P < .001) and vs olopatadine (P = .03) and mometasone (P = .02). Similar significant improvements in iTNSS were also observed with GSP301 (P < .05 for all). Furthermore, GSP301 significantly improved overall ocular symptoms, individual nasal and ocular symptoms, and quality of life vs placebo (P ≤ .001 for all). Onset of action for GSP301 was observed within 15 minutes and was maintained at all subsequent timepoints. Treatment-emergent AEs occurred in 15.6%, 12.6%, 9.6%, and 9.5% of patients in the GSP301, olopatadine, mometasone, and placebo groups, respectively. CONCLUSION GSP301 is efficacious and well tolerated vs placebo for treating SAR-associated nasal and ocular symptoms, with a rapid onset of action of 15 minutes in adult and adolescent patients 12 years and older. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02870205.
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Affiliation(s)
- Gary N Gross
- Pharmaceutical Research & Consulting Inc, Dallas, Texas.
| | - Gary Berman
- Clinical Research Institute Inc, Minneapolis, Minnesota
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Patel P, Salapatek AM, Tantry SK. Effect of olopatadine-mometasone combination nasal spray on seasonal allergic rhinitis symptoms in an environmental exposure chamber study. Ann Allergy Asthma Immunol 2018; 122:160-166.e1. [PMID: 30321655 DOI: 10.1016/j.anai.2018.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND GSP301 nasal spray is a fixed-dose combination of the antihistamine olopatadine hydrochloride and the corticosteroid mometasone furoate intended for seasonal allergic rhinitis (SAR) treatment. OBJECTIVE To evaluate the efficacy and safety of once-daily or twice-daily GSP301 in a ragweed pollen environmental exposure chamber. METHODS In this randomized, double-blind, double-dummy study, adults (18-65 years old) with SAR were equally randomized to 665 μg of olopatadine and 25 μg of mometasone (twice-daily GSP301), 665 μg of olopatadine and 50 μg of mometasone (once-daily GSP301), a US Food and Drug Administration-approved formulation of 137 μg of azelastine and 50 μg of fluticasone twice-daily (AzeFlu), a US Food and Drug Administration-approved formulation of 665 μg of olopatadine twice-daily, or placebo (twice-daily). During 2 visits (baseline and end of 14-day treatment), participants assessed SAR symptoms at specified time points. The primary end point-mean change from baseline in instantaneous total nasal symptom score (iTNSS) for twice-daily or once-daily GSP301 vs placebo-was analyzed by analysis of covariance. Onset of action, ocular symptoms, and adverse events were assessed. RESULTS A total of 180 participants were randomized. Treatment with twice-daily or once-daily GSP301 provided statistically significant improvements in iTNSS vs placebo (twice-daily GSP301: least squares mean difference, -3.60; 95% confidence interval [CI], -4.89 to -2.30; once-daily GSP301: least squares mean difference, -3.05; 95% CI, -4.35 to -1.76; P < .0001 for both). Significant improvements in iTNSS with twice-daily GSP301 occurred by 10 minutes after dosing (-1.26; 95% CI, -2.30 to -0.21; P = .02) and were maintained at all later time points except one (2.5 hours). Treatment-emergent adverse events occurred in 22.2%, 30.6%, 25.0%, 22.2%, and 16.7% of participants in the twice-daily GSP301, once-daily GSP301, AzeFlu, olopatadine, and placebo groups, respectively. CONCLUSION In an environmental exposure chamber model, twice-daily and once-daily GSP301 treatments were well tolerated and provided statistically significant and clinically meaningful SAR symptom improvement vs placebo. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03444506.
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Affiliation(s)
- Piyush Patel
- Inflamax Research Inc, Mississauga, Ontario, Canada.
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Gänger S, Schindowski K. Tailoring Formulations for Intranasal Nose-to-Brain Delivery: A Review on Architecture, Physico-Chemical Characteristics and Mucociliary Clearance of the Nasal Olfactory Mucosa. Pharmaceutics 2018; 10:pharmaceutics10030116. [PMID: 30081536 PMCID: PMC6161189 DOI: 10.3390/pharmaceutics10030116] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/25/2018] [Accepted: 08/01/2018] [Indexed: 12/17/2022] Open
Abstract
The blood-brain barrier and the blood-cerebrospinal fluid barrier are major obstacles in central nervous system (CNS) drug delivery, since they block most molecules from entering the brain. Alternative drug delivery routes like intraparenchymal or intrathecal are invasive methods with a remaining risk of infections. In contrast, nose-to-brain delivery is a minimally invasive drug administration pathway, which bypasses the blood-brain barrier as the drug is directed from the nasal cavity to the brain. In particular, the skull base located at the roof of the nasal cavity is in close vicinity to the CNS. This area is covered with olfactory mucosa. To design and tailor suitable formulations for nose-to-brain drug delivery, the architecture, structure and physico-chemical characteristics of the mucosa are important criteria. Hence, here we review the state-of-the-art knowledge about the characteristics of the nasal and, in particular, the olfactory mucosa needed for a rational design of intranasal formulations and dosage forms. Also, the information is suitable for the development of systemic or local intranasal drug delivery as well as for intranasal vaccinations.
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Affiliation(s)
- Stella Gänger
- Institute of Applied Biotechnology, University of Applied Sciences Biberach, Hubertus-Liebrecht-Strasse 35, 88400 Biberach, Germany.
- Faculty of Medicine, University of Ulm, Albert-Einstein-Allee 11, 89081 Ulm, Germany.
| | - Katharina Schindowski
- Institute of Applied Biotechnology, University of Applied Sciences Biberach, Hubertus-Liebrecht-Strasse 35, 88400 Biberach, Germany.
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Altuntaş E, Yener G. Formulation and Evaluation of Thermoreversible In Situ Nasal Gels Containing Mometasone Furoate for Allergic Rhinitis. AAPS PharmSciTech 2017; 18:2673-2682. [PMID: 28281209 DOI: 10.1208/s12249-017-0747-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/21/2017] [Indexed: 11/30/2022] Open
Abstract
The purpose of the present work was to develop a mucoadhesive thermoreversible nasal gel with a tailored gelling temperature to provide the prolonged contact between mometasone furoate and the nasal mucosa and in order to prevent drainage of the formulation. For this purpose, in situ gel containing a thermogelling polymer poloxamer 407 (Pluronic® F-127) and a mucoadhesive polymer Carbopol® 974P NF was prepared. In this content, formulations were designed to have gelation temperature below 34°C to obtain gelation at intranasal cavity. Evaluation of the prepared in situ gels was carried out by the determination of sol-gel transition temperature, rheological and mechanical characteristics, mucoadhesion strength, drug content, physicochemical stability, in vitro release profiles, and ex vivo permeation across sheep nasal mucosa of formulations. Consequently, the in situ gel (CP5) which had favorable gelation temperature (30.1 ± 0.24°C), rheological and mechanical characteristics, in vitro release profile (T%100 180 min), and mucoadhesion strength (0.289 ± 0.0069 mJ) was developed. Consequently, the in situ gel system has been concluded as a promising approach in order to improve the therapeutic effects of intranasal mometasone furoate administration.
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Chi CC, Kirtschig G, Aberer W, Gabbud JP, Lipozenčić J, Kárpáti S, Haustein UF, Wojnarowska F, Zuberbier T. Updated evidence-based (S2e) European Dermatology Forum guideline on topical corticosteroids in pregnancy. J Eur Acad Dermatol Venereol 2017; 31:761-773. [DOI: 10.1111/jdv.14101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- C.-C. Chi
- Department of Dermatology; Chang Gung Memorial Hospital; Linkou and College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - G. Kirtschig
- Department of Dermatology; University of Marburg; Marburg Germany
| | - W. Aberer
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - J.-P. Gabbud
- Dermatologist, retired from private practice; Bern Switzerland
| | - J. Lipozenčić
- Department of Dermatology and Venereology; Zagreb University Hospital Center and School of Medicine; Zagreb Croatia
| | - S. Kárpáti
- Department of Dermatology, Venereology and Dermato-oncology; Semmelweis University; Budapest Hungary
| | - U.-F. Haustein
- Department of Dermatology, Venerology and Allergology; University of Leipzig; Leipzig Germany
| | - F. Wojnarowska
- Nuffield Department of Clinical Medicine; University of Oxford; Oxford UK
| | - T. Zuberbier
- Allergy-Centre-Charité; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Berlin Germany
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Caniga M, Cabal A, Mehta K, Ross DS, Gil MA, Woodhouse JD, Eckman J, Naber JR, Callahan MK, Goncalves L, Hill SE, Mcleod RL, McIntosh F, Freke MC, Visser SA, Johnson N, Salmon M, Cicmil M. Preclinical Experimental and Mathematical Approaches for Assessing Effective Doses of Inhaled Drugs, Using Mometasone to Support Human Dose Predictions. J Aerosol Med Pulm Drug Deliv 2016; 29:362-77. [PMID: 26859446 DOI: 10.1089/jamp.2015.1253] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Michael Caniga
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Antonio Cabal
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Khamir Mehta
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - David S. Ross
- Center for Applied and Computational Mathematics, Rochester Institute of Technology, Rochester, New York
| | - Malgorzata A. Gil
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Janice D. Woodhouse
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Joseph Eckman
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - John R. Naber
- Department of Discovery Pharmaceutical Sciences, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Marissa K. Callahan
- Department of Discovery Pharmaceutical Sciences, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Luciano Goncalves
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Susan E. Hill
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Robbie L. Mcleod
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Fraser McIntosh
- Discovery Research Services Charles River Laboratories, Senneville, Quebec, Canada
| | - Mark C. Freke
- Discovery Research Services Charles River Laboratories, Senneville, Quebec, Canada
| | - Sandra A.G. Visser
- Department of Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Neil Johnson
- Department of Safety Assessment and Laboratory Animal Sciences, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Michael Salmon
- Department of Biology Discovery, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
| | - Milenko Cicmil
- Department of Pharmacology, Merck Research Laboratories, Boston, Massachusetts, and West Point, Pennsylvania
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Meteran H, Backer V. Mometasone furoate nasal spray for the treatment of asthma. Expert Opin Investig Drugs 2016; 25:999-1004. [PMID: 27218300 DOI: 10.1080/13543784.2016.1192124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Asthma is a common respiratory disease characterized by airway inflammation, bronchoconstriction and airway hyperresponsiveness and symptoms such as coughing, wheezing, shortness of breath and chest tightness. Allergic rhinitis is a common comorbidity in asthma and glucocorticoids are the key stone in the treatment of both diseases. Mometasone furoate is a potent synthetic steroid with a very high receptor affinity and a low bioavailability and shown to be superior compared to other inhaled corticosteroids. It is not clear whether the use of mometasone furoate nasal spray (MFNS) is associated with an improvement in asthma control. AREAS COVERED This current paper reviews the current knowledge on the effect of mometasone furoate nasal spray in the treatment of asthma and includes clinical trials in which both subjective and objective outcomes are assessed. EXPERT OPINION To date, only few clinical studies have investigated the effect of nasal steroids in the treatment of asthma. The studies investigating the effect of MFNS report contradicting results, although the most well-designed study to answer this question finds no improvement in asthma control. Thus, it seems unlikely that asthma guidelines will be influenced by the current knowledge on the effect of MFNS in the treatment of asthma.
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Affiliation(s)
- Howraman Meteran
- a Respiratory Research Unit , Bispebjerg University Hospital , Copenhagen , Denmark
| | - Vibeke Backer
- a Respiratory Research Unit , Bispebjerg University Hospital , Copenhagen , Denmark
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Chudiwal SS, Dehghan MHG. Quality by design approach for development of suspension nasal spray products: a case study on budesonide nasal suspension. Drug Dev Ind Pharm 2016; 42:1643-52. [PMID: 26943653 DOI: 10.3109/03639045.2016.1160108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to provide quality by design (QbD) approach for development of suspension type nasal spray products. Quality target product profile (QTPP) of test product budesonide nasal suspension (B-NS) was defined and critical quality attributes (CQAs) were identified. Critical formulation, process and delivery device variables were recognized. Risk assessment was performed by using failure mode and effect analysis (FMEA) methodology. Selected variables were further assessed using a Plackett Burman screening study. A response surface design consisting of the critical factors was used to study the interactions between the study variables. Formulation variable X2: median particle size of budesonide (D50) (µ) has strikingly influenced dissolution (%) (Y1), while D50 droplet size distribution (µm) (Y2) was significantly impacted by formulation variable X1: Avicel RC 591 (%) and process variable X4: homogenization speed (rpm). A design space plot within which the CQAs remained unchanged was established at lab scale. A comprehensive approach for development of B-NS product based on the QbD methodology has been demonstrated. The accuracy and robustness of the model were confirmed by comparability of the predicted value generated by model with the observed value.
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Mometasone furoate in the treatment of mild, moderate, or severe persistent allergic rhinitis: a non-inferiority study (PUMA). Braz J Otorhinolaryngol 2016; 82:580-8. [PMID: 26968623 PMCID: PMC9444672 DOI: 10.1016/j.bjorl.2015.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/29/2015] [Accepted: 11/02/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Allergic rhinitis is considered the most prevalent respiratory disease in Brazil and worldwide, with great impact on quality of life, affecting social life, sleep, and also performance at school and at work. Objective To compare the efficacy and safety of two formulations containing mometasone furoate in the treatment of mild, moderate, or severe persistent allergic rhinitis after four weeks of treatment. Methods Phase III, randomized, non-inferiority, national, open study comparing mometasone furoate in two presentations (control drug and investigational drug). The primary endpoint was the percentage of patients with reduction of at least 0.55 in nasal index score (NIS) after four weeks of treatment. Secondary outcomes included total nasal index score score after four and 12 weeks of treatment; individual scores for symptoms of nasal obstruction, rhinorrhea, sneezing, and nasal pruritus; as well as score for pruritus, lacrimation, and ocular redness after four and 12 weeks of treatment. The study was registered at clinicaltrials.gov with the reference number NCT01372865. Results The efficacy primary analysis demonstrated non-inferiority of the investigational drug in relation to the control drug, since the upper limit of the confidence interval (CI) of 95% for the difference between the success rates after four weeks of treatment (12.6%) was below the non-inferiority margin provided during the determination of the sample size (13.7%). Adverse events were infrequent and with mild intensity in most cases. Conclusion The efficacy and safety of investigational drug in the treatment of persistent allergic rhinitis were similar to the reference product, demonstrating its non-inferiority.
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Aksoy F, Dogan R, Kocak I, Veyseller B, Ozturan O, Incir S. Effect of Nasal Corticosteroid on Secretory Immunoglobulin A Measured in Rat Nasal Lavage: Experimental Study. Otolaryngol Head Neck Surg 2015; 153:298-301. [PMID: 26084823 DOI: 10.1177/0194599815589073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/08/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In this study, we aimed to experimentally investigate the effects of nasal corticosteroids on the levels of secretory immunoglobulin A (sIgA) in nasal mucosa in rats. STUDY DESIGN Prospective, randomized control trial. SETTING Research laboratory. SUBJECT AND METHODS Twenty-four male Sprague Dawley rats were included in our study. The rats were randomized into 3 groups. In group 1, nasal mometasone furoate was applied to the rats for 30 days. Saline was applied to group 2 for 30 days. Group 3 was the control group and received no treatment throughout the study period. Nasal lavage was conducted on both nasal openings of all rats in the 3 groups at the beginning of the study and on days 15 and 30, and the lavage solution (distilled water) was collected by aspiration. RESULTS In group 1, the sIgA value was significantly higher at day 15 than at baseline. No significant difference was found between the sIgA values on day 15 and day 30. In groups 2 and 3, there were no significant differences in sIgA values at baseline, day 15, and day 30. The sIgA value of group 1 on day 15 was significantly higher than the values of groups 2 and 3. The sIgA value of group 1 on day 30 was significantly higher than the values of groups 2 and 3. CONCLUSION Topical corticosteroids (mometasone furoate) applied to the nasal mucosa significantly increase nasal sIgA levels.
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Affiliation(s)
- Fadlullah Aksoy
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Remzi Dogan
- Bayrampasa State Hospital, Department of Otorhinolaryngology, Bayrampasa, Istanbul, Turkey
| | - Ilker Kocak
- Koç University, Department of Otorhinolaryngology, Sarıyer, Istanbul, Turkey
| | - Bayram Veyseller
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Said Incir
- Istanbul University, Cerrahpasa School of Medicine Department of Biochemistry, Fatih, Istanbul, Turkey
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Feng S, Nie L, Zou P, Suo J. Drug-loaded PLGA-mPEG microparticles as treatment for atopic dermatitis-like skin lesions in BALB/c mice model. J Microencapsul 2014; 32:201-9. [DOI: 10.3109/02652048.2014.995727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ow R, Groppo E, Clutter D, Gawlicka AK. Steroid-eluting sinus implant for in-office treatment of recurrent polyposis: a pharmacokinetic study. Int Forum Allergy Rhinol 2014; 4:816-22. [PMID: 25256638 DOI: 10.1002/alr.21414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/04/2014] [Accepted: 08/20/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term use of systemic glucocorticoid therapy has been associated with hypothalamic-pituitary-adrenal axis suppression and other systemic adverse events. This pharmacokinetic study evaluated the systemic safety and performance of a bioabsorbable sinus implant that gradually releases 1350 μg of mometasone furoate directly to the sinus mucosa. METHODS A prospective, single-center study treating 5 adult patients with recurrent polyposis after bilateral total ethmoidectomy. Each patient received 2 steroid-releasing implants in-office under local/topical anesthesia. Plasma concentrations of mometasone furoate and cortisol were determined before placement and through 30-day follow-up, which also included endoscopic grading and patient-reported outcomes. RESULTS Five patients (mean age 46.2 ± 9.2 standard deviation [SD] years; 60% male) underwent successful placement in all 10 ethmoid sinuses. There were no serious adverse events. The plasma concentrations of mometasone furoate were generally below the lower limit of quantification (LLOQ) of the assay (30 pg/mL). Cortisol concentrations at follow-up ranged from 3.9 to 5.7 mg/dL compared to 4.7 mg/dL at baseline. At 1 month, there was a significant improvement in bilateral polyp grade (p = 0.037), nasal obstruction score (p = 0.002), and 22-item Sino-Nasal Outcome Test (SNOT-22) (p = 0.010) compared to baseline. CONCLUSION The reported 100% placement success, negligible systemic exposure to mometasone furoate released over time, lack of adrenal suppression, and the absence of serious adverse events suggest that the implant provides a valid and safe option for the in-office treatment of recurrent polyposis. Randomized, controlled, blinded clinical studies are underway to provide further evidence of safety and efficacy.
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Affiliation(s)
- Randall Ow
- Sacramento Ear, Nose and Throat, Roseville, CA
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Marcia Murphy K, Olivry T. The influence of mometasone furoate ear solution on intradermal test immediate reactions in dogs with atopic dermatitis. Vet Dermatol 2014; 26:31-4, e9-10. [DOI: 10.1111/vde.12171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K. Marcia Murphy
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; 1052 William Moore Drive Raleigh NC 27607 USA
- Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; 1052 William Moore Drive Raleigh NC 27607 USA
| | - Thierry Olivry
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; 1052 William Moore Drive Raleigh NC 27607 USA
- Center for Comparative Medicine and Translational Research; College of Veterinary Medicine; North Carolina State University; 1052 William Moore Drive Raleigh NC 27607 USA
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Aksoy F, Demirhan H, Bayraktar Gİ, Yıldırım YS, Ozturan O, Gönüllü N, Sapmaz B. Effect of nasal mometasone furoate on the nasal and nasopharyngeal flora. Auris Nasus Larynx 2011; 39:180-5. [PMID: 21889281 DOI: 10.1016/j.anl.2011.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 04/15/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Mometasone furoate (MF) is one of the commonly used topical steroids, particularly for patients with allergic rhinitis. However, its effect on the colonization of bacteria that may cause superinfections by suppressing the local immunity is not known. Thus, we investigated the effect of MF use on the nasal and nasopharyngeal microbial flora. MATERIALS AND METHODS Swab samples were taken from 35 patients who required MF monotherapy, just before and after one month of the treatment. Samples were maintained in Stuart's medium. Each swab was transferred to 1ml of a sterile saline solution, then into the standard agar. After incubation under 5% carbon dioxide at 37°C, colony number was detected per ml. RESULTS Colony counts of nasal or nasopharyngeal microbial flora did not show any statistically significant alteration with one month use of MF. However, an increase in potential pathogens as well as normal flora bacteria was determined in five of the patients and six patients acquired new nasopharyngeal potential pathogens, mostly Moraxella catarrhalis, Pseudomonas aeruginosa and Staphylococcus aureus, following the use of MF. CONCLUSION The use of MF for one month did not statistically significantly change the nasal and nasopharyngeal flora. This study indicates that MF could be increase the colonization of the potential pathogens in some of the patients at the subclinical level particularly in the nasopharyngeal area.
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Affiliation(s)
- Fadlullah Aksoy
- Bezmialem Vakıf University, Medical Faculty, Department of Otorhinolaryngology and Head and Neck Surgery, Istanbul, Turkey
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Berlucchi M, Pedruzzi B. Intranasal Mometasone Furoate for Treatment of Allergic Rhinitis. ACTA ACUST UNITED AC 2010. [DOI: 10.4137/cmt.s4767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Allergic rhinitis (AR) is a chronic nasal disease that affects the upper respiratory tract. This disorder is characterized by inflammation of the mucous membranes and it manifests with several nasal symptoms accompanied sometimes by non-nasal symptoms. Best therapy aims to prevent and improve the AR-clinical picture. Steroids have an important role in the treatment of AR. The development of steroids administrated directly on nasal mucosa has much reduced the systemic adverse affects associated with oral steroids therapy. Mometasone furoate aqueous nasal spray is a synthetic steroid assessed for intranasal use in the therapy of adults and children affected by AR. Such topical nasal steroid is an effective molecule improving clinical picture of AR and it is also approved as prophylactic therapy. In this article, apart from a careful description of its successful clinical use the authors review pharmacokinetic/pharmacodynamic profile, mechanism of action, safety, and efficacy of such steroid molecule.
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Affiliation(s)
- Marco Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - Barbara Pedruzzi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
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Watelet JB, Gillard M, Benedetti MS, Lelièvre B, Diquet B. Therapeutic management of allergic diseases. Drug Metab Rev 2009; 41:301-43. [PMID: 19601717 DOI: 10.1080/10837450902891204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Allergic diseases are characterized by the activation of inflammatory cells and by a massive release of mediators. The aim of this chapter was to describe succinctly the modes of action, indications, and side effects of the major antiallergic and antiasthmatic drugs. When considering the ideal pharmacokinetic characteristics of a drug, a poorly metabolized drug may confer a lower variability in plasma concentrations and metabolism-based drug interactions, although poorly metabolized drugs may be prone to transporter-based disposition and interactions. The ideal pharmacological properties of a drug include high binding affinity, high selectivity, and appropriate association and dissociation rates. Finally, from a patient perspective, the frequency and route of administration are important considerations for ease of use.
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Affiliation(s)
- Jean-Baptiste Watelet
- Department of Otohinolaryngology, Head and Neck Surgery, Ghent University Hospital, Ghent University, Belgium.
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Benedetti MS, Whomsley R, Poggesi I, Cawello W, Mathy FX, Delporte ML, Papeleu P, Watelet JB. Drug metabolism and pharmacokinetics. Drug Metab Rev 2009; 41:344-90. [PMID: 19601718 DOI: 10.1080/10837450902891295] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In this article, aspects of absorption, distribution, metabolism, and excretion have been described bearing in mind the pathogenesis of allergic diseases and their possible therapeutic opportunities. The importance of the routes of administration of the different therapeutic groups has been emphasized. The classical aspects of drug metabolism and disposition related to oral administration have been reviewed, but special emphasis has been given to intranasal, cutaneous, transdermal, and ocular administration as well as to the absorption and the subsequent bioavailability of drugs. Drug-metabolizing enzymes and transporters present in extrahepatic tissues, such as nasal mucosa and the respiratory tract, have been particularly discussed. As marketed antiallergic drugs include both racemates and enantiomers, aspects of stereoselective absorption, distribution, metabolism, and excretion have been discussed. Finally, a new and promising methodology, microdosing, has been presented, although it has not yet been applied to drugs used in the treatment of allergic diseases.
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Baumann D, Bachert C, Högger P. Dissolution in nasal fluid, retention and anti-inflammatory activity of fluticasone furoate in human nasal tissue ex vivo. Clin Exp Allergy 2009; 39:1540-50. [PMID: 19538495 DOI: 10.1111/j.1365-2222.2009.03306.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intranasal glucocorticoids represent the most effective pharmacologic treatment of allergic rhinitis. So far, no clinical data are available that compare fluticasone furoate (FF) with other intranasally applied glucocorticoids. OBJECTIVE Because the pharmacokinetic behaviour of drugs governs their presence at the therapeutic target site we analysed selected in vitro properties of FF in comparison with triamcinolone acetonide (TCA), budesonide (Bud), fluticasone propionate (FP) and mometasone furoate (MF). Additionally, we determined the anti-inflammatory activity of the glucocorticoid fraction residing in human nasal tissue samples after washing. METHODS We analysed the solubility of the compounds in artificial human nasal fluid and the retention in human nasal tissue as well as typical spray volumes of commercially available drug preparations. As an anti-inflammatory measure, we evaluated the inhibition of IL-8 release from epithelial cells. RESULTS FF is delivered in the smallest application volume per spray. Despite the low aqueous solubility of glucocorticoids, a fraction of the compounds is already dissolved in the aqueous supernatants of drug preparations (Bud>TCA>FP>MF>FF). The dissolution of FP, MF and FF was significantly enhanced in artificial nasal fluid and FF displayed the most pronounced enhancement of solubility in the presence of proteins. Consistent with this result, the highest retention in nasal tissue was observed for FF, followed by FP>MF>Bud>TCA. After washing of the nasal tissue samples, all compounds inhibited IL-8 release, with FF displaying the highest activity. CONCLUSION FF displayed beneficial properties for nasal application. Its low application volume per spray is a prerequisite for effective drug utilization by avoiding immediate loss by nose runoff or drip down the throat. Sustained dissolution and high tissue binding of FF should contribute towards an extended presence of compounds in nasal tissue as a basis for a prolonged pharmacologic activity.
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Affiliation(s)
- D Baumann
- Institut für Pharmazie und Lebensmittelchemie, Universität Würzburg, Würzburg, Germany
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:177-84. [DOI: 10.1097/aci.0b013e328329f9ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Mometasone furoate (Nasonex) is a high-potency intranasal corticosteroid available for the treatment and/or prophylaxis of the nasal symptoms of seasonal allergic rhinitis (SAR) and perennial allergic rhinitis (PAR). In the EU, it is approved for use in patients aged > or =6 years and, in the US, it is approved as a treatment in patients aged > or =2 years and as prophylaxis in those > or =12 years of age.Extensive experience in both clinical trials and the clinical practice setting has firmly established the efficacy and good tolerability profile of intranasal mometasone furoate in children and adults with PAR or SAR. Thus, intranasal mometasone furoate is a useful first-line option for the treatment and prophylactic management of these conditions, including in children as young as 2 years of age in some countries and 6 years of age in others.
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Relative receptor affinity comparisons among inhaled/intranasal corticosteroids: perspectives on clinical relevance. Respir Res 2008; 9:75. [PMID: 19025651 PMCID: PMC2613397 DOI: 10.1186/1465-9921-9-75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 11/24/2008] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusion
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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