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Cox CA, Boudewijn IM, Vroegop SJ, Schokker S, Lexmond AJ, Frijlink HW, Hagedoorn P, Vonk JM, Farenhorst MP, Ten Hacken NHT, Kerstjens HAM, Postma DS, van den Berge M. Extrafine compared to non-extrafine particle inhaled corticosteroids in smokers and ex-smokers with asthma. Respir Med 2017; 130:35-42. [PMID: 29206631 DOI: 10.1016/j.rmed.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Smoking is as prevalent in asthmatics as in the general population. Asthmatic smokers benefit less from inhaled corticosteroids (ICS) than non-smoking asthmatics, possibly due to more smoking-induced small airways disease. Thus targeting small airways may be important in treating asthmatic (ex-)smokers. We hypothesized that extrafine particle ICS improve small airways function more than non-extrafine particle ICS in asthmatic (ex-)smokers. METHODS We performed an open-label, randomized, three-way cross-over study comparing extrafine beclomethasone (HFA-QVAR) to non-extrafine beclomethasone (HFA-Clenil) and fluticasone (HFA-Flixotide) in 22 smokers and 21 ex-smokers with asthma (?5 packyears). RESULTS Improvement from baseline in PD20 adenosine after using QVAR, Clenil or Flixotide was 1.04 ± 1.71, 1.09 ± 2.12 and 0.94 ± 1.97 doubling doses, mean ± standard deviation (SD), respectively. The change from baseline in R5-R20 at PD20 adenosine after using QVAR, Clenil or Flixotide was ?0.02 ± 0.27, 0.02 ± 0.21, and ?0.02 ± 0.31 kPa sL?1, mean ± SD, respectively. The change in PD20 adenosine and R5-R20 at PD20 adenosine were neither statistically significant different between QVAR and Clenil (p = 0.86 and p = 0.82) nor between QVAR and Flixotide (p = 0.50 and p = 0.96). CONCLUSION Similar effectiveness in improving small airways function was found for extrafine and non-extrafine particle ICS treatment for asthmatic smokers and ex-smokers.
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Affiliation(s)
- Claire A Cox
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
| | - Ilse M Boudewijn
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
| | - Sebastiaan J Vroegop
- Martini Hospital Groningen, Department of Pulmonary Diseases, PO Box 30.033, 9700 RM Groningen, The Netherlands.
| | - Siebrig Schokker
- Martini Hospital Groningen, Department of Pulmonary Diseases, PO Box 30.033, 9700 RM Groningen, The Netherlands.
| | - Anne J Lexmond
- University of Groningen, Department of Pharmaceutical Technology and Biopharmacy, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Henderik W Frijlink
- University of Groningen, Department of Pharmaceutical Technology and Biopharmacy, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Paul Hagedoorn
- University of Groningen, Department of Pharmaceutical Technology and Biopharmacy, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Judith M Vonk
- University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Martijn P Farenhorst
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
| | - Nick H T Ten Hacken
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
| | - Huib A M Kerstjens
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
| | - Dirkje S Postma
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
| | - Maarten van den Berge
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, PO Box 30.0001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Groningen Research Institute for Asthma and COPD, PO Box 30.0001, 9700 RB Groningen, The Netherlands.
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Price D, Thomas M, Haughney J, Lewis RA, Burden A, von Ziegenweidt J, Chisholm A, Hillyer EV, Corrigan CJ. Real-life comparison of beclometasone dipropionate as an extrafine- or larger-particle formulation for asthma. Respir Med 2013; 107:987-1000. [PMID: 23643486 DOI: 10.1016/j.rmed.2013.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 02/12/2013] [Accepted: 03/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Beclometasone dipropionate is an inhaled corticosteroid (ICS) available in both extrafine and larger-particle hydrofluoroalkane formulations. Extrafine beclometasone has greater small airway distribution and inhalation technique tolerance than larger-particle beclometasone; therefore, its use may be associated with improved asthma outcomes at population levels. The study objective was to compare real-life effectiveness of extrafine and larger-particle beclometasone. METHODS Retrospective matched cohort study including primary care patients with asthma (ages 12-60 and non-smokers 61-80 years) prescribed extrafine or larger-particle beclometasone by metered-dose inhaler. We studied patients receiving their first ICS (initiation population, n = 11,289) or switched from another ICS without dose change (switch population, n = 19,065). The extrafine and larger-particle beclometasone cohorts were matched in each population for demographic and database measures of asthma control during a baseline year; and endpoints assessed during 1 outcome year were adjusted for residual confounding factors. RESULTS The odds of no loss of asthma control (no asthma-related hospital attendance, consultation for lower respiratory tract infection, or oral corticosteroids) were significantly higher in the extrafine beclometasone cohorts of both initiation population (adjusted odds ratio [aOR] 1.12; 95% CI 1.02-1.23) and switch population (aOR 1.10; 95% CI 1.01-1.19). The odds of better adherence to ICS therapy were also significantly higher in both extrafine beclometasone cohorts (initiation population, aOR 1.64; 95% CI 1.52-1.75 and switch population, aOR 1.35; 95% CI 1.27-1.43). CONCLUSIONS These findings are consistent with the hypothesis that delivery of beclometasone in extrafine particle size produces real-life asthma treatment benefits. Clinical trials no. NCT01400217.
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Affiliation(s)
- David Price
- Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Nicolini G, Scichilone N, Bizzi A, Papi A, Fabbri LM. Beclomethasone/formoterol fixed combination for the management of asthma: patient considerations. Ther Clin Risk Manag 2008; 4:855-64. [PMID: 19209268 PMCID: PMC2621423 DOI: 10.2147/tcrm.s3126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Drugs for asthma and other chronic obstructive diseases of the lungs should be preferably delivered by the inhalation route to match therapeutic effects with low systemic exposure. Inhaled drugs are delivered to the lungs via different devices, mainly metered dose inhalers and dry powder inhalers, each characterized by specific inhaler technique and instructions for use. The patient-device interaction is part of the prescribed therapy and can have a relevant impact on adherence and clinical outcomes. The most suitable device should be considered for each patient to assure the correct drug intake and adherence to the prescribed therapy. The development of new drugs/devices in the past decades improved the compliance with inhaler and possibly drug delivery to the bronchi. The present review focuses on the recently developed beclomethasone/formoterol extrafine fixed combination and technical aspects of drug delivery to the lungs in patient's perspective.
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Affiliation(s)
| | | | - Andrea Bizzi
- Department of Scientific Affairs, Chiesi Farmaceutici, Parma, Italy
| | - Alberto Papi
- Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Leonardo M Fabbri
- Section of Respiratory Diseases, University of Modena, Modena, Italy
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Acerbi D, Brambilla G, Kottakis I. Advances in asthma and COPD management: delivering CFC-free inhaled therapy using Modulite technology. Pulm Pharmacol Ther 2006; 20:290-303. [PMID: 16890465 DOI: 10.1016/j.pupt.2006.05.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/27/2006] [Accepted: 05/11/2006] [Indexed: 11/25/2022]
Abstract
Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are currently used in the management of asthma and chronic obstructive pulmonary disease (COPD). Localized targeted delivery of these drugs into the lungs is achieved by means of two types of inhalation devices; pressurized metered-dose inhalers (pMDIs) and dry powder-inhalers (DPIs). For environmental reasons, the chlorofluorocarbon (CFC) propellants used in pMDIs are now being replaced by ozone friendly hydrofluoroalkanes (HFAs). These new generation HFA-based pMDIs, developed to provide effective lung deposition of the active moiety, have a favorable safety and tolerability profile. However, HFA-based re-formulation of LABAs and ICS for pMDIs presents particular technical difficulties, especially in terms of ensuring dose content uniformity. This review focuses on the technology and clinical efficacy of the HFA solution pMDIs using Modulite platform technology (Chiesi Farmaceutici S.p.A). Modulite technology allows the development of HFA solution formulations that can mimic the established CFC-based drug formulations on a microgram to microgram basis and provides formulations with novel particle size distributions that improve on existing delivery systems; by manipulation of aerosol clouds and particle size, the delivery of HFA-formulated drugs can be optimized to either achieve fine particle fractions and deposition patterns similar to established CFC-based drug formulations, thus facilitating the transition to new environment-friendly pMDIs in the clinical setting, or achieve finer drug particles able to penetrate deeper into the bronchi for targeted drug delivery as medical need may dictate. Long-term, multiple-dose clinical studies of Modulite formulations of beclomethasone dipropionate (BDP), budesonide and formoterol have been demonstrated to be therapeutically equivalent to their respective previously established CFC or DPI formulations. As a result, a number of Modulite pMDIs have either recently gained regulatory approval in several European countries, or have completed clinical trials and are in the regulatory submission phase. Availability, in pMDI form, of drugs like formoterol, ICSs, and ICS/LABA combinations, all central to the effective management of asthma and COPD, is therefore expected to impact positively in assuring the continued availability of vital treatment options to patients and physicians.
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Affiliation(s)
- D Acerbi
- Chiesi Farmaceutici S.p.A, Drug Metabolism and Pharmacokinetics, Via Palermo 26/A, 43100 Parma, Parma, Italy.
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Derom E, Pauwels RA. Pharmacokinetic and pharmacodynamic properties of inhaled beclometasone dipropionate delivered via hydrofluoroalkane-containing devices. Clin Pharmacokinet 2006; 44:815-36. [PMID: 16029067 DOI: 10.2165/00003088-200544080-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Inhaled corticosteroids have a key role in the treatment of asthma and chronic obstructive pulmonary disease. In recent times, beclometasone dipropionate has been reformulated in pressurised metered dose inhalers (pMDIs), using hydrofluoroalkanes (HFAs) as a propellant. Extensive toxicological testing has shown that HFA-propellants are well tolerated. Among the reformulated beclometasone dipropionate-containing pMDIs, only the characteristics of the two Qvar formulations have been thoroughly explored. Compared to the reference beclometasone dipropionate formulation, the mass median aerodynamic diameter of the Qvar formulations are substantially smaller (1.1 vs 4.0 microm), whereas that of Modulite averages 2.6 microm. Scintigraphic and pharmacokinetic studies indicate a higher lung deposition for both the Qvar and the Beclazone formulations, compared with reference beclometasone dipropionate formulation. Since the 2- to 3-fold increase in pulmonary deposition results in a 2.6- to 3-fold difference in relative efficacy for Qvar, half the dose of the reference beclometasone dipropionate formulation has been currently recommended in adult patients with asthma, a recommendation that is supported by a large number of clinical trials. Conversely, the design of the studies conducted to compare the efficacy of Qvar with fluticasone propionate and budesonide does not allow establishing their equivalence on a milligram per milligram basis. Good studies on the bioequivalence between the reference beclometasone dipropionate formulation and the Modulite or Beclazone formulations are not available.
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Affiliation(s)
- Eric Derom
- Department of Respiratory Diseases, Ghent University Hospital, De pintelaan 185, B-9000 Gent, Belgium.
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Bousquet J, Guenolé E, Duvauchelle T, Vicaut E, Lefrançois G. A randomized, double-blind, double-dummy, single-dose, crossover trial evaluating the efficacy and safety profiles of two dose levels (12 and 24 microg) of formoterol-HFA (pMDI) vs. those of a dose level (24 microg) of formoterol-DPI (Foradil/Aerolizer) and of placebo (pMDI or Aerolizer) in moderate to severe asthmatic patients. Respiration 2005; 72 Suppl 1:13-9. [PMID: 15915008 DOI: 10.1159/000083688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chlorofluorocarbons (CFCs) have traditionally been used as propellants in pressurized metered-dose inhalers (pMDIs), which are often used to deliver drugs to the lungs for the treatment of reversible obstructive airways diseases. However, CFCs are harmful to the environment and need to be phased out. In response to that phase-out of environmentally harmful CFCs, the pharmaceutical industry is developing a new generation of pMDI formulations for the inhaled treatment of asthma. These formulations contain hydrofluoroalkanes (HFAs) in redesigned metered-dose inhalers. OBJECTIVES This study primarily sought to establish clinical equivalence between a new HFA-formulated formoterol pMDI and the conventional formoterol DPI in the treatment of patients with moderate-to-severe asthma. METHODS We enrolled 51 patients aged 18-70 years old who had stable persistent asthma. All patients were randomized to receive a single dose of each of the following 4 treatments in a double-blind, crossover manner: formoterol HFA pMDI 24 microg, formoterol HFA pMDI 12 microg, formoterol DPI 24 microg or placebo. RESULTS Of the 51 patients randomised, 46 were evaluable for efficacy. The 12-hour average FEV1 was 2.885, 2.746, 2.916 and 2.353 liters in the HFA 24-microg, HFA 12-microg, DPI 24-microg and placebo groups, respectively. Assessment of 95% CIs revealed that the HFA pMDI 24-microg and DPI formulations were equivalent and that both were significantly superior to placebo (p < 0.001). Improvements in lung function were also significantly superior to placebo in the HFA 12-microg group, but the effect was more moderate than that observed in the higher dose groups. CONCLUSIONS This study indicates that the formoterol HFA-formulated pMDI provides equivalent bronchodilating effect to the formoterol DPI at the 24-microg dose.
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Affiliation(s)
- J Bousquet
- Hôpital Arnaud de Villeneuve, Montpellier, France.
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