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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.
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Affiliation(s)
| | - Olof Selroos
- Independent Researcher, 25266 Helsingborg, Sweden;
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2
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Wongsurakiat P, Rattanawongpaibul A, Limsukon A, Chiewchalermsri C, Wiwatcharagoses K, Kornthatchapong K, Saiphoklang N, Sanguanwit P, Domthong P, Kawamatawong T, Sewatanon T, Reechaipichitkul W, Maneechotesuwan K. Expert panel consensus recommendations on the utilization of nebulized budesonide for managing asthma and COPD in both stable and exacerbation stages in Thailand. J Asthma 2024:1-16. [PMID: 38527278 DOI: 10.1080/02770903.2024.2334897] [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: 01/15/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE This study investigated the utilization of nebulized budesonide for acute asthma and COPD exacerbations as well as for maintenance therapy in adults. DATA SOURCES We conducted a search on PubMed for nebulized budesonide treatment. SELECTED STUDIES Selecting all English-language papers that utilize Mesh phrases "asthma," "COPD," "budesonide," "nebulized," "adult," "exacerbation," and "maintenance" without temporal restrictions, and narrowing down to clinical research such as RCTs, observational studies, and real-world studies. RESULTS Analysis of 25 studies was conducted to assess the effectiveness of nebulized budesonide in asthma (n = 10) and COPD (n = 15). The panel in Thailand recommended incorporating nebulized budesonide as an additional or alternative treatment option to the standard of care and systemic corticosteroids (SCS) based on the findings. CONCLUSION Nebulized budesonide is effective and well-tolerated in treating asthma and COPD, with less systemic adverse effects compared to systemic corticosteroids. High-dose nebulized budesonide can enhance clinical outcomes for severe and mild exacerbations with slow systemic corticosteroid response. Nebulized budesonide can substitute systemic corticosteroids in some situations.
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Affiliation(s)
- Phunsup Wongsurakiat
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Atikun Limsukon
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chirawat Chiewchalermsri
- Department of Internal Medicine, Panyananthaphikkhu Chonprathan Medical Center Srinakharinwirot University, Nonthaburi, Thailand
| | - Kittiyaporn Wiwatcharagoses
- Department of Emergency Medicine, Faculty of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Narongkorn Saiphoklang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornanan Domthong
- Division of Pulmonary and Critical Care Division, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | - Theerasuk Kawamatawong
- Associate Professor of Medicine, General Secretariate, Thai Asthma Council (TAC), Bangkok, Thailand
| | - Tirachat Sewatanon
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Wipa Reechaipichitkul
- Division of Pulmonary and Critical Care Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittipong Maneechotesuwan
- Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Drug delivery using a surfactant vehicle has the potential to prevent systemic side effects by delivering therapeutic agents directly to the respiratory system. The inherent chemical properties of surfactant allows it to readily distribute throughout the respiratory system. Therapeutic agents delivered by surfactant can primarily confer additional benefits but have potential to improve surfactant function. It is critically important that additional agents do not interefere with the innate surface tension lowering function of surfactant. Systemic evaluation through benchtop, translational and human trials are required to translate this potential technique into clinical practice.
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Affiliation(s)
- Arun Sett
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Victoria, Australia.
| | - Charles C Roehr
- Newborn Services, Southmead Hospital, North Bristol NHS Trust Bristol, Bristol, UK; Faculty of Health Sciences, University of Bristol, Bristol, UK; Oxford Population Health, National Perinatal Epidemiology Unit, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Brett J Manley
- Newborn Research, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
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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: 0] [Impact Index Per Article: 0] [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".
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Affiliation(s)
- Ralph Brattsand
- Experimental Pharmacology, Budera Company, Kristinehamn, Sweden.
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5
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Choi JH, Jeong KB, Park YH, Yu I, Lee SJ, Lee MK, Kim SH, Lee WY, Yong SJ, Lee JH. Comparison of Risk of Pneumonia Caused by Fluticasone Propionate versus Budesonide in Chronic Obstructive Pulmonary Disease: A Nationwide Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:3229-3237. [PMID: 34858023 PMCID: PMC8629914 DOI: 10.2147/copd.s332151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/14/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Inhaled corticosteroids (ICSs) play an important role in lowering the risk of acute exacerbation of chronic obstructive pulmonary disease (COPD). However, ICSs are known to increase the risk of pneumonia. Moreover, previous studies have shown that the incidence rate of pneumonia varies depending on the type of ICS. In this study, the risk of pneumonia according to the type of ICS was investigated in a population-based cohort. Methods A retrospective cohort study was conducted using claims data of the entire population from the Korean National Health Insurance Service. Patients who were newly diagnosed with COPD and prescribed fluticasone propionate or budesonide were enrolled as study subjects. Cumulative doses of ICSs were classified into categorical variables to analyze the risk of pneumonia within identical ICS doses. Results A total of 47,473 subjects were identified and allocated as 14,518 fluticasone propionate and 14,518 budesonide users through 1:1 propensity score matching. Fluticasone propionate users were more likely to develop pneumonia than budesonide users (14.22% vs 10.66%, p<0.0001). The incidence rate per 100,000 person-years was 2,914.77 for fluticasone propionate users and 2,102.90 for budesonide users. The hazard ratio (HR) of pneumonia in fluticasone propionate compared to budesonide was 1.34 (95% CI 1.26–1.43, p<0.0001). The risk of pneumonia for fluticasone propionate compared to budesonide increased with higher ICS cumulative doses: 1.06 (0.93–1.21), 1.41 (1.19–1.66), 1.41 (1.23–1.63), and 1.49 (1.33–1.66) from the lowest to highest quartiles, respectively. Conclusion ICS types and doses need to be carefully considered during treatment with ICSs in patients with COPD.
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Affiliation(s)
- Jae-Hwa Choi
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Keun-Bae Jeong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - You Hyun Park
- Department of Biostatistics, Yonsei University, Seoul, Korea
| | - Iseul Yu
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Cimato A, Facorro G, Martínez Sarrasague M. Budesonide associated with exogenous pulmonary surfactant in a novel formulation to improve the delivery to the lung. Respir Physiol Neurobiol 2021; 296:103825. [PMID: 34808585 DOI: 10.1016/j.resp.2021.103825] [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: 09/02/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
Lung delivery for glucocorticoids (GCs) is very low and depends on the system used. Exogenous pulmonary surfactant (EPS) is a promising tool to transporting GCs efficiently to the airways. We developed a new formulation of EPS with Budesonide (BUD) incorporated into EPS membranes (EPS-BUD) to improve lung delivery of BUD. We evaluated the biodistribution and pharmacokinetic of the transported BUD by intra-tracheal instillation of EPS-BUD in healthy rats. Aqueous suspension of Budesonide was used as control. Budesonide and its esters present in trachea, kidneys and lungs were determined by HPLC. The delivery of BUD in lung for EPS-BUD group was 75 % of total instilled and only 35 % for the control group. BUD was rapidly internalized in pneumocytes and a high proportion of Budesonide esters and persistent concentrations of active free BUD were found for up to 6 h after instillation. The new EPS-BUD formulation developed significantly improves the deposition and increases the permanence of BUD in lung.
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Affiliation(s)
- Alejandra Cimato
- Cátedra de Física, Departamento de Fisicomatemática, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Graciela Facorro
- Cátedra de Física, Departamento de Fisicomatemática, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Margarita Martínez Sarrasague
- Cátedra de Física, Departamento de Fisicomatemática, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
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Selo MA, Sake JA, Kim KJ, Ehrhardt C. In vitro and ex vivo models in inhalation biopharmaceutical research - advances, challenges and future perspectives. Adv Drug Deliv Rev 2021; 177:113862. [PMID: 34256080 DOI: 10.1016/j.addr.2021.113862] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022]
Abstract
Oral inhalation results in pulmonary drug targeting and thereby reduces systemic side effects, making it the preferred means of drug delivery for the treatment of respiratory disorders such as asthma, chronic obstructive pulmonary disease or cystic fibrosis. In addition, the high alveolar surface area, relatively low enzymatic activity and rich blood supply of the distal airspaces offer a promising pathway to the systemic circulation. This is particularly advantageous when a rapid onset of pharmacological action is desired or when the drug is suffering from stability issues or poor biopharmaceutical performance following oral administration. Several cell and tissue-based in vitro and ex vivo models have been developed over the years, with the intention to realistically mimic pulmonary biological barriers. It is the aim of this review to critically discuss the available models regarding their advantages and limitations and to elaborate further which biopharmaceutical questions can and cannot be answered using the existing models.
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8
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Abstract
The study of enzyme kinetics in drug metabolism involves assessment of rates of metabolism and inhibitory potencies over a suitable concentration range. In all but the very simplest in vitro system, these drug concentrations can be influenced by a variety of nonspecific binding reservoirs that can reduce the available concentration to the enzyme system(s) under investigation. As a consequence, the apparent kinetic parameters, such as Km or Ki, that are derived can deviate from the true values. There are a number of sources of these nonspecific binding depots or barriers, including membrane permeation and partitioning, plasma or serum protein binding, and incubational binding. In the latter case, this includes binding to the assay apparatus as well as biological depots, depending on the characteristics of the in vitro matrix being used. Given the wide array of subcellular, cellular, and recombinant enzyme systems utilized in drug metabolism, each of these has different components which can influence the free drug concentration. The physicochemical properties of the test compound are also paramount in determining the influential factors in any deviation between true and apparent kinetic behavior. This chapter describes the underlying mechanisms determining the free drug concentration in vitro and how these factors can be accounted for in drug metabolism studies, illustrated with case studies from the literature.
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Affiliation(s)
- Nigel J Waters
- Preclinical Development, Black Diamond Therapeutics, Cambridge, MA, USA
| | - R Scott Obach
- Pharmacokinetics, Dynamics and Metabolism, Pfizer Inc, Groton, CT, USA
| | - Li Di
- Pharmacokinetics, Dynamics and Metabolism, Pfizer Inc, Groton, CT, USA
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Anderson CD, Kothe TB, Josephsen JB, Sadiq FH, Burleyson N, Williams HL, Hillman NH. Budesonide mixed with surfactant did not affect neurodevelopmental outcomes at 6 or 18 months corrected age in observational cohorts. J Perinatol 2021; 41:1681-1689. [PMID: 33986470 PMCID: PMC8117121 DOI: 10.1038/s41372-021-01066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/10/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The addition of budesonide to surfactant in very-low-birth-weight infants with less severe RDS decreased bronchopulmonary dysplasia (BPD) severity. Long-term neurodevelopmental follow-up was needed to monitor for systemic effects of budesonide. METHODS Infants ≤1250 g who received intratracheal budesonide (0.25 mg/kg) with surfactant (n = 173) were compared to a historical cohort who received surfactant alone (n = 294). Peabody Developmental Motor Scales II at 4-6 months corrected age and Bayley Scales of Infant & Toddler Development III at 18-22 months corrected age were compared. RESULTS There were no differences in muscle tone or motor skills by Peabody exam. There were no differences in the cognitive, language, or motor domains between cohorts on Bayley III. CONCLUSIONS In a cohort of infants treated with budesonide mixed with surfactant, there were no differences in developmental outcomes at 4-6 months or 18-22 months corrected age.
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Affiliation(s)
- Connie D. Anderson
- grid.262962.b0000 0004 1936 9342Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children’s Hospital, St. Louis, MO USA
| | - T. Brett Kothe
- grid.262962.b0000 0004 1936 9342Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children’s Hospital, St. Louis, MO USA ,grid.241128.c0000 0004 0435 2118Division of Neonatology, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN USA
| | - Justin B. Josephsen
- grid.262962.b0000 0004 1936 9342Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children’s Hospital, St. Louis, MO USA
| | - Farouk H. Sadiq
- grid.262962.b0000 0004 1936 9342Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children’s Hospital, St. Louis, MO USA
| | - Nikki Burleyson
- grid.413397.b0000 0000 9893 168XSSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO USA
| | - Howard L. Williams
- grid.413397.b0000 0000 9893 168XSSM Health Cardinal Glennon Children’s Hospital, St. Louis, MO USA
| | - Noah H. Hillman
- grid.262962.b0000 0004 1936 9342Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children’s Hospital, St. Louis, MO USA
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Lodise TP, Li J, Gandhi HN, O'Brien G, Sethi S. Intraclass Difference in Pneumonia Risk with Fluticasone and Budesonide in COPD: A Systematic Review of Evidence from Direct-Comparison Studies. Int J Chron Obstruct Pulmon Dis 2020; 15:2889-2900. [PMID: 33204085 PMCID: PMC7667513 DOI: 10.2147/copd.s269637] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Inhaled corticosteroids (ICS) are widely used and recommended to treat chronic obstructive pulmonary disease (COPD). While generally considered safe, several studies demonstrated an increased risk of pneumonia with the use of ICS in COPD patients. Although all ICS indicated for COPD carry the class labeling warning of increased pneumonia risk, evidence suggests an intraclass difference in the risk of pneumonia between inhaled budesonide and fluticasone. To date, systematic reviews of direct-comparison studies have not been performed to assess if an intraclass difference exists. Research Question This review investigated whether there is an intraclass difference in risk of pneumonia between inhaled fluticasone and budesonide, the 2 most commonly used ICS in COPD. Study Design and Methods A search of the medical literature was conducted in PubMed and Embase for the time period of 01/01/69–05/31/19. The search strategy combined terms that defined the patient/disease type, exposures, outcome, and the study/publication type. Descriptive and comparative statistics reported for fluticasone- and budesonide-containing products in each study, including data for pneumonia event subgroups, were extracted and reported by dose, seriousness, or practice setting. Controlled clinical trials and observational studies meeting the inclusion criteria were assessed for methodologic quality by using the appropriate tool from the list of study quality assessment tools developed by the National Institutes of Health. Results The summary relative risk (RR) ratio across 5 included studies (57,199 patients) was 1.13 (95% CI: 1.09–1.19), representing a 13.5% increased risk of pneumonia among fluticasone users compared to budesonide users. Similarly, summary RR ratio for serious pneumonia implied a 14.4% increased risk of serious pneumonia among fluticasone users compared to budesonide users (pooled RR: 1.14; 95% CI: 1.09–1.20). Interpretation There is likely a clinically important intraclass difference in the risk of pneumonia between fluticasone- and budesonide-containing inhaled medications in COPD.
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Affiliation(s)
- Thomas P Lodise
- Department of Pharmacy Practice, Albany College Pharmacy and Health Sciences, Albany, NY, USA
| | - Jingyi Li
- Global Medical Affairs, AstraZeneca, Gaithersburg, MD, USA
| | | | - Gerald O'Brien
- US Respiratory Medical, AstraZeneca, Wilmington, DE, USA
| | - Sanjay Sethi
- Department of Medicine, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Hillman NH, Abugisisa L, Royse E, Fee E, Kemp MW, Kramer BW, Schmidt AF, Salomone F, Clarke MW, Musk GC, Jobe AH. Dose of budesonide with surfactant affects lung and systemic inflammation after normal and injurious ventilation in preterm lambs. Pediatr Res 2020; 88:726-732. [PMID: 32066138 PMCID: PMC8717708 DOI: 10.1038/s41390-020-0809-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/30/2020] [Accepted: 02/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The addition of budesonide (Bud) 0.25 mg/kg to surfactant decreased the lung and systemic responses to mechanical ventilation in preterm sheep and the rates and severity of bronchopulmonary dysplasia (BPD) in preterm infants. We hypothesized that lower budesonide concentrations in surfactant will decrease injury while decreasing systemic corticosteroid exposure. METHODS Preterm lambs received either (1) protective tidal volume (VT) ventilation with surfactant from birth or (2) injurious VT ventilation for 15 min and then surfactant treatment. Lambs were further assigned to surfactant mixed with (i) Saline, (ii) Bud 0.25 mg/kg, (iii) Bud 0.1 mg/kg, or (iv) Bud 0.04 mg/kg. All lambs were then ventilated with protective VT for 6 h. RESULTS Plasma Bud levels were proportional to the dose received and decreased throughout ventilation. In both protective and injurious VT ventilation, <4% of Bud remained in the lung at 6 h. Some of the improvements in physiology and markers of injury with Bud 0.25 mg/kg were also found with 0.1 mg/kg, whereas 0.04 mg/kg had only minimal effects. CONCLUSIONS Lower doses of Bud were less effective at decreasing lung and systemic inflammation from mechanical ventilation. The plasma Bud levels were proportional to dose given and the majority left the lung.
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Affiliation(s)
- Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, Saint Louis, MO, 63104, USA.
| | - Leenah Abugisisa
- Division of Neonatology, Cardinal Glennon Children’s Hospital, Saint Louis University, Saint Louis, MO 63104
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children’s Hospital, Saint Louis University, Saint Louis, MO 63104
| | - Erin Fee
- School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009
| | - Matthew W Kemp
- School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009
| | | | - Augusto F Schmidt
- Department of Pediatrics, Univ. Miami Miller School of Medicine, Miami, FL 33136
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA 6009, Australia
| | - Gabrielle C Musk
- School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009,Animal Care Services, University of Western Australia, Perth, WA, Australia 6009
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229,School of Women’s and Infants’ Health, University of Western Australia, Perth, WA, Australia 6009
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Castro-Rodriguez JA, Pincheira MA, Escobar-Serna DP, Sossa-Briceño MP, Rodriguez-Martinez CE. Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta-analysis. Pediatr Pulmonol 2020; 55:2508-2517. [PMID: 32658381 DOI: 10.1002/ppul.24956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022]
Abstract
UNLABELLED International guidelines have recommended the use of inhaled beta-2 agonists and systemic corticosteroids (SCs) as the first-line treatment for acute asthma. OBJECTIVE To evaluate the evidence for the efficacy of inhaled corticosteroids (ICSs) in addition to SCs compared to SCs alone in children with acute asthma in the emergency department (ED) or during hospitalization. DATA SOURCES Five electronic databases were searched. STUDY SELECTION All randomized clinical trials that compared ICS (via nebulizer or metered dose inhaler) plus SC (oral or parenteral) with placebo (or standard care) plus SC were included without language restriction. DATA EXTRACTION Two reviewers independently reviewed all the studies. The primary outcomes were hospital admission and hospital length of stay (LOS), and secondary outcomes were readmissions during follow-up, ED-LOS, lung function, asthma clinical score, oxygen saturation, and heart and respiratory rates. RESULTS Nine studies (n = 1473) met the inclusion criteria. In all the studies, the ICS was budesonide. Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreased hospital LOS by more than 1 day (MD = -29.08 hours [-39.9 to -18.3]; I2 = 0%, P = < .00001). Moreover, adding budesonide significantly improved the acute asthma severity score among patients at ED. CONCLUSIONS Compared to SC alone, adding budesonide to SC does not affect the hospitalization rate, but decreases the LOS and improves the acute asthma score in children in an ED setting.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio A Pincheira
- Department of Pediatric Pulmonology and Cardiology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diana P Escobar-Serna
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | | | - Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
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13
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Ruzycki CA, Murphy B, Nathoo H, Finlay WH, Martin AR. Combined in Vitro-in Silico Approach to Predict Deposition and Pharmacokinetics of Budesonide Dry Powder Inhalers. Pharm Res 2020; 37:209. [PMID: 32995953 DOI: 10.1007/s11095-020-02924-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE A combined in vitro - in silico methodology was designed to estimate pharmacokinetics of budesonide delivered via dry powder inhaler. METHODS Particle size distributions from three budesonide DPIs, measured with a Next Generation Impactor and Alberta Idealized Throat, were input into a lung deposition model to predict regional deposition. Subsequent systemic exposure was estimated using a pharmacokinetic model that incorporated Nernst-Brunner dissolution in the conducting airways to predict the net influence of dissolution, mucociliary clearance, and absorption. RESULTS DPIs demonstrated significant in vitro differences in deposition, resulting in large differences in simulated regional deposition in the central conducting airways and the alveolar region. Similar but low deposition in the small conducting airways was observed with each DPI. Pharmacokinetic predictions showed good agreement with in vivo data from the literature. Peak systemic concentration was tied primarily to the alveolar dose, while the area under the curve was more dependent on the total lung dose. Tracheobronchial deposition was poorly correlated with pharmacokinetic data. CONCLUSIONS Combination of realistic in vitro experiments, lung deposition modeling, and pharmacokinetic modeling was shown to provide reasonable estimation of in vivo systemic exposure from DPIs. Such combined approaches are useful in the development of orally inhaled drug products.
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Affiliation(s)
- Conor A Ruzycki
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Brynn Murphy
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Hafeez Nathoo
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Warren H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.
| | - Andrew R Martin
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.
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14
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Wang SH, Tsao PN. Phenotypes of Bronchopulmonary Dysplasia. Int J Mol Sci 2020; 21:ijms21176112. [PMID: 32854293 PMCID: PMC7503264 DOI: 10.3390/ijms21176112] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/18/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common chronic morbidity in preterm infants. In the absence of effective interventions, BPD is currently a major therapeutic challenge. Several risk factors are known for this multifactorial disease that results in disrupted lung development. Inflammation plays an important role and leads to persistent airway and pulmonary vascular disease. Since corticosteroids are potent anti-inflammatory agents, postnatal corticosteroids have been used widely for BPD prevention and treatment. However, the clinical responses vary to a great degree across individuals, and steroid-related complications remain major concerns. Emerging studies on the molecular mechanism of lung alveolarization during inflammatory stress will elucidate the complicated pathway and help discover novel therapeutic targets. Moreover, with the advances in metabolomics, there are new opportunities to identify biomarkers for early diagnosis and prognosis prediction of BPD. Pharmacometabolomics is another novel field aiming to identify the metabolomic changes before and after a specific drug treatment. Through this "metabolic signature," a more precise treatment may be developed, thereby avoiding unnecessary drug exposure in non-responders. In the future, more clinical, genetic, and translational studies would be required to improve the classification of BPD phenotypes and achieve individualized care to enhance the respiratory outcomes in preterm infants.
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Affiliation(s)
- Shih-Hsin Wang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan;
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100225, Taiwan
- Center for Developmental Biology & Regenerative Medicine, National Taiwan University, Taipei 100226, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 71013)
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15
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Lamy E, Mahjoubi A, Salvator H, Lambinet F, Devillier P, Grassin-Delyle S. Liquid chromatography-mass spectrometry method for the quantification of corticosteroids, β 2-adrenoreceptor agonists and anticholinergics in human hair. J Pharm Biomed Anal 2020; 190:113530. [PMID: 32861927 DOI: 10.1016/j.jpba.2020.113530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022]
Abstract
Pharmacological treatments of asthma and chronic obstructive pulmonary disease include medications such as inhaled corticosteroids, long- or short-acting β2-adrenoreceptor agonists and anticholinergics. There is an unmet need for the monitoring of adherence and drug exposure to those therapies since poor adherence and/or inhalation technique may impact the control of the disease and the pharmacological strategy. Since plasma therapeutic drug monitoring only reflects the body exposure in the last few hours, the measurement of hair drug concentrations may be of great interest to assess the chronic exposure. A liquid chromatography - tandem mass spectrometry method was therefore developed for the quantification of corticosteroids, β2-adrenoreceptor agonists and anticholinergics in human hair. The method was validated according to the European Medicines Agency and Food and Drug Administration guidelines. Sensitivity, accuracy and precision were excellent, allowing the quantification of drugs in the pg/mg range. The method was shown suitable for the analysis of clinical hair samples, demonstrating that it could be used for hair therapeutic drug monitoring in asthma or chronic obstructive pulmonary disease patients.
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Affiliation(s)
- Elodie Lamy
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France
| | - Ayoub Mahjoubi
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France
| | - Hélène Salvator
- Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France
| | - Françoise Lambinet
- Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France
| | - Philippe Devillier
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France; Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France
| | - Stanislas Grassin-Delyle
- Université Paris-Saclay, UVSQ, INSERM, Infection et inflammation, Département de Biotechnologie de la Santé, Montigny le Bretonneux, France; Hôpital Foch, Département des maladies des voies respiratoires, Suresnes, France.
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16
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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.
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17
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Kothe TB, Sadiq FH, Burleyson N, Williams HL, Anderson C, Hillman NH. Surfactant and budesonide for respiratory distress syndrome: an observational study. Pediatr Res 2020; 87:940-945. [PMID: 31715622 DOI: 10.1038/s41390-019-0663-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/03/2019] [Accepted: 10/05/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In preterm infants on moderately high ventilator support, the addition of budesonide to surfactant lowered bronchopulmonary dysplasia (BPD) rates by 20% without increased morbidity or mortality. The aim of this cohort comparison was to determine the safety and efficacy of the combination in infants with milder respiratory distress syndrome (RDS). METHODS In August 2016 we began administering budesonide (0.25 mg/kg) mixed with surfactant (Survanta 4 mL/kg) to all infants ≤ 1250 g who failed CPAP and required intubation. Infants were compared to a historical cohort (2013-2016) who received surfactant alone. RESULTS BPD or death did not change between the historical surfactant cohort (71%, n = 294) and the budesonide cohort (69%, n = 173). Budesonide was associated with a decrease in the need for continued mechanical ventilation, severe BPD type II or death (19-12%), grade III BPD or death (31-21%), and the median gestational age at discharge was 1 week earlier. Histologic chorioamnionitis was associated with decreased budesonide effects. Secondary morbidities (NEC, IVH, ROP, Sepsis) were similar. CONCLUSION Overall BPD rates remained unchanged with the addition of budesonide. Budesonide was associated with decreased severity of BPD, decreased mechanical ventilation use, earlier discharge, and similar short-term outcomes.
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Affiliation(s)
- T Brett Kothe
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.,Division of Neonatology, Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Farouk H Sadiq
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Nikki Burleyson
- SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Connie Anderson
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Noah H Hillman
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.
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18
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Hillman NH, Kothe TB, Schmidt AF, Kemp MW, Royse E, Fee E, Salomone F, Clarke MW, Musk GC, Jobe AH. Surfactant plus budesonide decreases lung and systemic responses to injurious ventilation in preterm sheep. Am J Physiol Lung Cell Mol Physiol 2020; 318:L41-L48. [PMID: 31617728 PMCID: PMC6985873 DOI: 10.1152/ajplung.00203.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/09/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022] Open
Abstract
Mechanical ventilation from birth with normal tidal volumes (VT) causes lung injury and systemic responses in preterm sheep. The addition of budesonide to surfactant therapy decreases these injury markers. Budesonide and surfactant will decrease the injury from injurious VT ventilation in preterm sheep. Lambs at 126 ± 1 day gestational age were ventilated from birth with either: 1) Normal VT [surfactant 200 mg/kg before ventilation, positive end expiratory pressure (PEEP) 5 cmH2O, VT 8 mL/kg] or 2) Injury VT (high pressure, 100% oxygen, no PEEP) for 15 min, then further randomized to surfactant + saline or surfactant + 0.25 mg/kg budesonide with Normal VT for 6 h. Lung function and lung, liver, and brain tissues were evaluated for indicators of injury. Injury VT + saline caused significant injury and systemic responses, and Injury VT + budesonide improved lung physiology. Budesonide decreased lung inflammation and decreased pro-inflammatory cytokine mRNA in the lung, liver, and brain to levels similar to Normal VT + saline. Budesonide was present in plasma within 15 min of treatment in both ventilation groups, and less than 5% of the budesonide remained in the lung at 6 h. mRNA sequencing of liver and periventricular white matter demonstrated multiple pathways altered by both Injury VT and budesonide and the combination exposure. In lambs receiving Injury VT, the addition of budesonide to surfactant improved lung physiology and decreased pro-inflammatory cytokine responses in the lung, liver, and brain to levels similar to lambs receiving Normal VT.
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Affiliation(s)
- Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, Missouri
| | - T Brett Kothe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, Missouri
| | - Augusto F Schmidt
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, Missouri
| | - Erin Fee
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology R&D, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, Western Australia, Australia
| | - Gabrielle C Musk
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
- Animal Care Services, University of Western Australia, Perth, Western Australia, Australia
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
- School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
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19
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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.
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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
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20
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Caniga M, Yu H, Lee HH, Wang M, Witter D, Salmon M, Fan PW. Estimation of Fraction Dissolved After Intratracheal Delivery of a Potent Janus Kinase Inhibitor, iJAK-001, with Low Solubility in Rat and Sheep: Impact of Preclinical PKPD on Inhaled Human Dose Projection. J Aerosol Med Pulm Drug Deliv 2019; 32:251-265. [PMID: 31084462 DOI: 10.1089/jamp.2018.1492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: A highly potent pan-Janus kinase (JAK) inhibitor with excellent kinome selectivity was developed for topical delivery to treat severe asthma. This poorly soluble drug discovery candidate, iJAK-001, is expected to exhibit long duration of JAK/STAT pathway inhibition at low doses in asthmatics because of depot effect after dry powder inhalation. Human dose projection for inhaled molecules with low aqueous solubility remains to be a daunting challenge because of several limitations: (1) bioanalytical measurement of dissolved fraction after inhalation of solid particles is uncertain; (2) distribution of these particles is not homogenous in the lung; (3) in vitro solubility measurements to estimate fraction dissolved may not be a reflection of local surface lung concentration; (4) lack of a surrogate biomarker of lung target engagement, and (5) invasive procedure needed to sample human lung tissue in the clinic. Methods: We leveraged in silico, in vitro, and in vivo tools preclinically and found significant differences in lung to plasma partition ratio when iJAK-001 was given intravenously (IV) or intratracheally in a solution-based formulation versus that in suspension, as well as pharmacodynamic response in preclinical asthma models when delivered systemically via IV infusion versus inhaled. Results and Conclusion: The combined results from above suggest that caution must be exercised using either lung or plasma exposure for human dose projection. Instead, using the local inhibitor concentration estimate based on delivery efficiency, dose, fraction absorbed, and rate of absorption normalized by lung (cardiac) blood flow may be more appropriate for dose projection.
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Affiliation(s)
- Michael Caniga
- Department of In Vivo Pharmacology, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc.Boston, Massachusetts
| | - Hongshi Yu
- Department of Discovery Pharmaceutical Sciences, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc.Boston, Massachusetts
| | - Hyun-Hee Lee
- Department of Discovery Immunology, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc.Boston, Massachusetts
| | - Meiyao Wang
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc.Boston, Massachusetts
| | - David Witter
- Preclinical Research, Cullinan Oncology, Cambridge, Massachusetts
| | - Michael Salmon
- Platform Translation and Development, Emulate, Inc., Boston, Massachusetts
| | - Peter W Fan
- Department of Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc.Boston, Massachusetts
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21
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Kothe TB, Kemp MW, Schmidt A, Royse E, Salomone F, Clarke MW, Musk GC, Jobe AH, Hillman NH. Surfactant plus budesonide decreases lung and systemic inflammation in mechanically ventilated preterm sheep. Am J Physiol Lung Cell Mol Physiol 2019; 316:L888-L893. [PMID: 30838863 PMCID: PMC6589588 DOI: 10.1152/ajplung.00477.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/14/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
Mechanical ventilation with normal tidal volumes (VT) causes lung and systemic inflammation in preterm sheep. Mechanical ventilation is associated with bronchopulmonary dysplasia (BPD) in preterm infants, and the addition of budesonide to surfactant decreases BPD in clinical trials. Budesonide with surfactant will decrease the lung injury from mechanical ventilation for 24 h in preterm sheep. Lambs at 126 ± 1 day gestational age were delivered and randomized to either: 1) surfactant (200 mg/kg) or 2) surfactant mixed with budesonide (0.25 mg/kg) before mechanical ventilation with VT of 7-8 ml/kg for 2, 6, or 24 h (n = 6 or 7/group). Lung physiology and budesonide levels in the plasma and the lung were measured. Lung tissue, bronchoalveolar lavage fluid (BALF), liver, and brain tissues were evaluated for indicators of injury. High initial budesonide plasma levels of 170 ng/ml decreased to 3 ng/ml at 24 h. Lung tissue budesonide levels were less than 1% of initial dose by 24 h. Although physiological variables were generally similar, budesonide-exposed lambs required lower mean airway pressures, had higher hyperoxia responses, and had more stable blood pressures. Budesonide decreased proinflammatory mRNA in the lung, liver, and brain. Budesonide also decreased total protein and proinflammatory cytokines in BALF, and decreased inducible nitric oxide synthase activation at 24 h. In ventilated preterm lambs, most of the budesonide left the lung within 24 h. The addition of budesonide to surfactant improved physiology, decreased markers of lung injury, and decreased systemic responses in liver and brain.
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Affiliation(s)
- T Brett Kothe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , St. Louis, Missouri
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
| | - Augusto Schmidt
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , St. Louis, Missouri
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology R&D, Chiesi Farmaceutici S.p.A., Parma , Italy
| | - Michael W Clarke
- Metabolomics Australia, Centre for Microscopy, Characterisation and Analysis, The University of Western Australia , Perth, Western Australia , Australia
| | - Gabrielle C Musk
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
- Animal Care Services, University of Western Australia , Perth, Western Australia , Australia
| | - Alan H Jobe
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio
| | - Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , St. Louis, Missouri
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22
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Tang B, Wang J, Luo LL, Li QG, Huang D. Risks of budesonide/formoterol for the treatment of stable COPD: a meta-analysis. Int J Chron Obstruct Pulmon Dis 2019; 14:757-766. [PMID: 31015757 PMCID: PMC6448539 DOI: 10.2147/copd.s192166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this study was to investigate the comparative risks of budesonide/formoterol, versus placebo or monotherapies, for the treatment of patients with stable COPD. Materials and methods We undertook a systematic search of the literature in PubMed, Embase, and the Cochrane Central Register of Controlled Trials, for randomized controlled trials (RCTs) comparing budesonide/formoterol with control regimens for the treatment of patients with stable COPD and at least 12 weeks of follow-up, meeting the inclusion criteria. Studies were reviewed, and OR with corresponding 95% CI was used to pool the results. Results A total of eight studies involving 9,254 patients met the inclusion criteria of this meta-analysis. Compared with placebo, combination therapy with budesonide/formoterol was associated with a significantly higher risk of adverse effects including oral candidiasis (OR: 3.09, 95% CI: 1.95–4.91) and dysphonia (OR: 2.76, 95% CI: 1.40–5.44), but not pneumonia (OR: 0.94, 95% CI: 0.64–1.37) or bronchitis (OR: 1.36, 95% CI: 0.95–1.95). A similar pattern was also evident for the comparison of formoterol with budesonide/formoterol, with increased occurrence of oral candidiasis (OR: 2.72, 95% CI: 1.33–5.58) and dysphonia (OR: 4.13, 95% CI: 1.95–8.76); however, there were no significant differences in pneumonia (OR: 1.31, 95% CI: 0.98–1.74) or bronchitis (OR: 1.05, 95% CI: 0.83–1.31). In contrast, compared with budesonide, combined budesonide/formoterol was associated with similar risks of adverse effects, including pneumonia (OR: 1.20, 95% CI: 0.60–2.39), bronchitis (OR: 0.95, 95% CI: 0.41–2.20), oral candidiasis (OR: 0.79, 95% CI: 0.41–1.53), and dysphonia (OR: 1.00, 95% CI: 0.40–2.47). Conclusion Combination therapy does not cause more adverse events, including pneumonia and bronchitis, than control (placebo, formoterol, or budesonide) treatment in patients with stable COPD, while there were higher risks of oral candidiasis and dysphonia compared with the non-inhaled corticosteroid group (placebo, formoterol).
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Affiliation(s)
- Bin Tang
- Department of Respiratory Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No. 92 Aiguo Road, Nanchang, 330006, Jiangxi, China,
| | - Jun Wang
- Department of Respiratory Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No. 92 Aiguo Road, Nanchang, 330006, Jiangxi, China,
| | - Lin-Lin Luo
- Department of Respiratory Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No. 92 Aiguo Road, Nanchang, 330006, Jiangxi, China,
| | - Qiu-Gen Li
- Department of Respiratory Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No. 92 Aiguo Road, Nanchang, 330006, Jiangxi, China,
| | - Dan Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China,
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23
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Provost KA, Smith M, Miller-Larsson A, Gudleski GD, Sethi S. Bacterial regulation of macrophage bacterial recognition receptors in COPD are differentially modified by budesonide and fluticasone propionate. PLoS One 2019; 14:e0207675. [PMID: 30677037 PMCID: PMC6345465 DOI: 10.1371/journal.pone.0207675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Rationale Patients with COPD have an increased risk for community-acquired pneumonia, which is further increased by inhaled corticosteroids. Objective To assess effects of the corticosteroids, budesonide and fluticasone propionate, on macrophage bacterial responses in COPD. Methods Monocyte-derived macrophages (MDMs) generated from blood monocytes from 10 non-smoker controls (NoS), 20 smokers without COPD (Sm), and 40 subjects with moderate to severe COPD (21 ex-smokers (COPD-ES) and 19 current smokers (COPD-S)) were pre-treated with budesonide or fluticasone (10 nM—1 μM) and challenged with live non-typeable Haemophilus influenzae (NTHI) or Streptococcus pneumoniae (SP). Cell surface bacterial recognition receptor expression (flow cytometry) and cytokine release (bead array) were analyzed. Results NTHI and SP reduced bacterial recognition receptor expression on MDMs from COPD and Sm, but not NoS (except TLR4). SR-AI and MARCO were reduced by both NTHI and SP, whereas other receptors by either NTHI or SP. Among COPD subjects, COPD-ES demonstrated a greater number of reductions as compared to COPD-S. NTHI reduced SR-AI, MARCO, CD11b, CD35 and CD206 in COPD-ES while only SR-AI and CD11b in COPD-S. SP reduced SRA-1, CD1d, TLR2 and TLR4 in both COPD-ES and COPD-S, and reduced MARCO and CD93 only in COPD-ES. All receptors reduced in COPD by NTHI and most by SP, were also reduced in Sm. Budesonide counteracted the receptor reductions induced by both NTHI (CD206 p = 0.03, MARCO p = 0.08) and SP (SR-AI p = 0.02) in COPD-ES. Fluticasone counteracted only SP-induced reductions in TLR2 (p = 0.008 COPD-ES and p = 0.04 COPD-S) and TLR4 (p = 0.02 COPD-ES). Cytokine release was equivalently reduced by both corticosteroids. Conclusions Reduction in macrophage bacterial recognition receptors during bacterial exposure could provide a mechanism for the increased pneumonia risk in COPD. Differential effects of budesonide and fluticasone propionate on macrophage bacterial recognition receptor expression may contribute to the higher pneumonia incidence reported with fluticasone propionate.
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Affiliation(s)
- Karin A. Provost
- Veterans Health Administration, Veterans Affairs Western New York Healthcare System at Buffalo, Division of Pulmonary, Critical Care and Sleep Medicine, Buffalo, New York, United States of America
- University at Buffalo, State University of New York, Jacobs School of Medicine and Biomedical Sciences, Division of Pulmonary, Critical Care and Sleep Medicine, Buffalo, New York, United States of America
- * E-mail:
| | - Miyuki Smith
- Veterans Health Administration, Veterans Affairs Western New York Healthcare System at Buffalo, Division of Pulmonary, Critical Care and Sleep Medicine, Buffalo, New York, United States of America
| | | | - Gregory D. Gudleski
- University at Buffalo, State University of New York, Jacobs School of Medicine and Biomedical Sciences, Department of Medicine, Buffalo, New York, United States of America
| | - Sanjay Sethi
- Veterans Health Administration, Veterans Affairs Western New York Healthcare System at Buffalo, Division of Pulmonary, Critical Care and Sleep Medicine, Buffalo, New York, United States of America
- University at Buffalo, State University of New York, Jacobs School of Medicine and Biomedical Sciences, Division of Pulmonary, Critical Care and Sleep Medicine, Buffalo, New York, United States of America
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24
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Kothe TB, Royse E, Kemp MW, Schmidt A, Salomone F, Saito M, Usuda H, Watanabe S, Musk GC, Jobe AH, Hillman NH. Effects of budesonide and surfactant in preterm fetal sheep. Am J Physiol Lung Cell Mol Physiol 2018; 315:L193-L201. [PMID: 29671605 DOI: 10.1152/ajplung.00528.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mechanical ventilation causes lung injury and systemic inflammatory responses in preterm sheep and is associated with bronchopulmonary dysplasia (BPD) in preterm infants. Budesonide added to surfactant decreased BPD by 20% in infants. We wanted to determine the effects of budesonide and surfactant on injury from high tidal volume (VT) ventilation in preterm lambs. Ewes at 125 ± 1 days gestational age had fetal surgery to expose fetal head and chest with placental circulation intact. Lambs were randomized to 1) mechanical ventilation with escalating VT to target 15 ml/kg by 15 min or 2) continuous positive airway pressure (CPAP) of 5 cmH2O. After the 15-min intervention, lambs were given surfactant 100 mg/kg with saline, budesonide 0.25 mg/kg, or budesonide 1 mg/kg. The fetuses were returned to the uterus for 24 h and then delivered and ventilated for 30 min to assess lung function. Budesonide levels were low in lung and plasma. CPAP groups had improved oxygenation, ventilation, and decreased injury markers compared with fetal VT lambs. Budesonide improved ventilation in CPAP lambs. Budesonide decreased lung weights and lung liquid and increased lung compliance and surfactant protein mRNA. Budesonide decreased proinflammatory and acute-phase responses in lung. Airway thickness increased in animals not receiving budesonide. Systemically, budesonide decreased monocyte chemoattractant protein-1 mRNA and preserved glycogen in liver. Results with 0.25 and 1 mg/kg budesonide were similar. We concluded that budesonide with surfactant matured the preterm lung and decreased the liver responses but did not improve lung function after high VT injury in fetal sheep.
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Affiliation(s)
- T Brett Kothe
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , Saint Louis, Missouri
| | - Emily Royse
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , Saint Louis, Missouri
| | - Matthew W Kemp
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
| | - Augusto Schmidt
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio
| | - Fabrizio Salomone
- Department of Preclinical Pharmacology Research and Development, Chiesi Farmaceutici, Parma , Italy
| | - Masatoshi Saito
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital , Sendai , Japan
| | - Haruo Usuda
- School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia.,Center for Perinatal and Neonatal Medicine, Tohoku University Hospital , Sendai , Japan
| | - Shimpei Watanabe
- Center for Perinatal and Neonatal Medicine, Tohoku University Hospital , Sendai , Japan
| | - Gabrielle C Musk
- Animal Care Services, University of Western Australia , Perth, Western Australia , Australia
| | - Alan H Jobe
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati , Cincinnati, Ohio.,School of Women's and Infants' Health, University of Western Australia , Perth, Western Australia , Australia
| | - Noah H Hillman
- Division of Neonatology, Cardinal Glennon Children's Hospital, Saint Louis University , Saint Louis, Missouri
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25
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van den Berge M, Jonker MR, Miller-Larsson A, Postma DS, Heijink IH. Effects of fluticasone propionate and budesonide on the expression of immune defense genes in bronchial epithelial cells. Pulm Pharmacol Ther 2018; 50:47-56. [PMID: 29627483 DOI: 10.1016/j.pupt.2018.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND COPD patients have increased risk of pneumonia when treated with fluticasone propionate (FP), whereas this is generally not the case with budesonide (BUD) treatment. We hypothesized that BUD and FP differentially affect the expression of immune defense genes. METHODS Human bronchial epithelial 16HBE cells and air-liquid interface (ALI)-cultured primary bronchial epithelial cells (PBECs) were pre-treated with clinically equipotent concentrations of BUD or FP (0.16-16 nM BUD and 0.1-10 nM FP), and the expression of immune defense genes was studied at baseline and after exposure to rhinovirus (RV16). RESULTS Using microfluidic cards, we observed that both BUD and FP significantly suppressed CXCL8, IFNB1 and S100A8 mRNA expression in unstimulated 16HBE cells. Interestingly, BUD, but not FP, significantly increased lactotransferrin (LTF) expression. The difference between the effect of BUD and FP on LTF expression was statistically significant and confirmed by qPCR and at the protein level by western blotting. RV16 infection of ALI-cultured PBECs significantly increased the expression of CCL20, IFNB1 and S100A8, but not of LTF or CAMP/LL-37. In these RV16-exposed cells, LTF expression was again significantly higher upon pre-treatment with BUD than with FP. The same was observed for S100A8, but not for CCL20, IFNB1 or CAMP/LL-37 expression. CONCLUSIONS Treatment of human bronchial epithelial cells with BUD results in significantly higher expression of specific immune defense genes than treatment with FP. The differential regulation of these immune defense genes may help to explain the clinical observation that BUD and FP treatment differ with respect to the risk of developing pneumonia in COPD.
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Affiliation(s)
- M van den Berge
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, GRIAC Research Institute, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - M R Jonker
- University of Groningen, University Medical Centre Groningen, Department of Pathology & Medical Biology, Experimental Pulmonology and Inflammation Research, Mölndal, Sweden
| | - A Miller-Larsson
- AstraZeneca Gothenburg, Department of Respiratory GMed, Mölndal, Sweden
| | - D S Postma
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, GRIAC Research Institute, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - I H Heijink
- University of Groningen, University Medical Centre Groningen, Department of Pulmonary Diseases, GRIAC Research Institute, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, GRIAC Research Institute, Groningen, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Pathology & Medical Biology, Experimental Pulmonology and Inflammation Research, Mölndal, Sweden.
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26
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Soulele K, Macheras P, Karalis V. On the pharmacokinetics of two inhaled budesonide/formoterol combinations in asthma patients using modeling approaches. Pulm Pharmacol Ther 2017; 48:168-178. [PMID: 29223508 DOI: 10.1016/j.pupt.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/27/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022]
Abstract
Dry powder inhalers containing the budesonide/formoterol combination have currently a well-established position among other inhaled products. Even though their efficacy mainly depends on the local concentrations of the drug they deliver within the lungs, their safety profile is directly related to their total systemic exposure. The aim of the present investigation was to explore the absorption and disposition kinetics of the budesonide/formoterol combination delivered via two different dry powder inhalers in asthma patients. Plasma concentration-time data were obtained from a single-dose, crossover bioequivalence study in asthma patients. Non-compartmental and population compartmental approaches were applied to the available datasets. The non-compartmental analysis allowed for an initial characterization of the primary pharmacokinetic (PK) parameters of the two inhaled drugs and subsequently the bioequivalence assessment of the two different dry powder inhalers. The population pharmacokinetic analysis further explored the complex absorption and disposition characteristics of the two drugs. In case of inhaled FOR, a five-compartment PK model including an enterohepatic re-circulation process was developed. For inhaled BUD, the incorporation of two parallel first-order absorption rate constants (fast and slow) for lung absorption in a two-compartment PK model emphasized the importance of pulmonary anatomical features and underlying physiological processes during model development. The role of potential covariates on the variability of the PK parameters was also investigated.
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Affiliation(s)
- K Soulele
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 157 84 Athens, Greece.
| | - P Macheras
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 157 84 Athens, Greece; Pharma-Informatics Unit of Research & Innovation Center ATHENA, 151 25 Maroussi, Greece.
| | - V Karalis
- Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 157 84 Athens, Greece; Institute of Applied and Computational Mathematics (IACM), Foundation of Research and Technology Hellas (FORTH), Greece.
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27
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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.
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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
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28
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Heijink IH, Jonker MR, de Vries M, van Oosterhout AJM, Telenga E, Ten Hacken NHT, Postma DS, van den Berge M. Budesonide and fluticasone propionate differentially affect the airway epithelial barrier. Respir Res 2016; 17:2. [PMID: 26739349 PMCID: PMC4704248 DOI: 10.1186/s12931-015-0318-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND COPD patients have a higher risk of pneumonia when treated with fluticasone propionate (FP) than with placebo, and a lower risk with budesonide (BUD). We hypothesized that BUD and FP differentially affect the mucosal barrier in response to viral infection and/or cigarette smoke. METHODS We assessed protective effects of equivalent concentrations of BUD and FP on cytokine production and barrier function (electrical resistance) in human bronchial epithelial 16HBE cells and primary bronchial epithelial cells (PBECs) upon exposure to viral mimetic poly-(I:C) and/or cigarette smoke extract (CSE) or epidermal growth factor (EGF). RESULTS BUD and FP were equally effective in suppressing poly-(I:C)- and/or CSE-induced IL-8 secretion in 16HBE and PBECs. Poly-(I:C) substantially decreased electrical resistance in 16HBE cells and both BUD and FP fully counteracted this effect. However, FP hardly affected 16HBE barrier dysfunction induced by CSE with/without poly-(I:C), whereas BUD (16 nM) provided full protection, an effect likely mediated by affecting EGFR-downstream target GSK-3β. Similarly, BUD, but not FP, significantly improved CSE-induced barrier dysfunction in PBECs. Finally, BUD, but not FP, exerted a modest but significant protective effect against Streptococcus Pneumoniae-induced barrier dysfunction, and BUD, but not FP, prevented cellular adhesion and/or internalization of these bacteria induced by poly-(I:C) in 16HBE. CONCLUSIONS Collectively, both BUD and FP efficiently control epithelial pro-inflammatory responses and barrier function upon mimicry of viral infection. Of potential clinical relevance, BUD more effectively counteracted CSE-induced barrier dysfunction, reinforcing the epithelial barrier and potentially limiting access of pathogens upon smoking in vivo.
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Affiliation(s)
- I H Heijink
- Department of Pathology & Medical Biology, Experimental Pulmonology and Inflammation Research, University of Groningen, University Medical Center Groningen,, Hanzeplein 1, NL-9713 GZ, Groningen, The Netherlands. .,Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands.
| | - M R Jonker
- Department of Pathology & Medical Biology, Experimental Pulmonology and Inflammation Research, University of Groningen, University Medical Center Groningen,, Hanzeplein 1, NL-9713 GZ, Groningen, The Netherlands
| | - M de Vries
- Department of Pathology & Medical Biology, Experimental Pulmonology and Inflammation Research, University of Groningen, University Medical Center Groningen,, Hanzeplein 1, NL-9713 GZ, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - A J M van Oosterhout
- Department of Pathology & Medical Biology, Experimental Pulmonology and Inflammation Research, University of Groningen, University Medical Center Groningen,, Hanzeplein 1, NL-9713 GZ, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - E Telenga
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - N H T Ten Hacken
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - D S Postma
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - M van den Berge
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
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29
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Waters NJ, Obach RS, Di L. Consideration of the unbound drug concentration in enzyme kinetics. Methods Mol Biol 2014; 1113:119-45. [PMID: 24523111 DOI: 10.1007/978-1-62703-758-7_7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
The study of enzyme kinetics in drug metabolism involves assessment of rates of metabolism and inhibitory potencies over a suitable concentration range. In all but the very simplest in vitro system, these drug concentrations can be influenced by a variety of nonspecific binding reservoirs that can reduce the available concentration to the enzyme system under investigation. As a consequence, the apparent kinetic parameters that are derived, such as K m or K i, can deviate from the true values. There are a number of sources of these nonspecific binding depots or barriers, including membrane permeation and partitioning, plasma or serum protein binding, and incubational binding. In the latter case, this includes binding to the assay apparatus, as well as biological depots, depending on the characteristics of the in vitro matrix being used. Given the wide array of subcellular, cellular, and recombinant enzyme systems utilized in drug metabolism, each of these has different components that can influence the free drug concentration. The physicochemical properties of the test compound are also paramount in determining the influential factors in any deviation between true and apparent kinetic behavior. This chapter describes the underlying mechanisms determining the free drug concentration in vitro and how these factors can be accounted for in drug metabolism studies, illustrated with case studies from the literature.
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Affiliation(s)
- Nigel J Waters
- Drug Metabolism and Pharmacokinetics, Epizyme Inc., Cambridge, MA, USA
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30
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Holden NS, George T, Rider CF, Chandrasekhar A, Shah S, Kaur M, Johnson M, Siderovski DP, Leigh R, Giembycz MA, Newton R. Induction of regulator of G-protein signaling 2 expression by long-acting β2-adrenoceptor agonists and glucocorticoids in human airway epithelial cells. J Pharmacol Exp Ther 2013; 348:12-24. [PMID: 24163441 DOI: 10.1124/jpet.113.204586] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In asthma and chronic obstructive pulmonary disease (COPD) multiple mediators act on Gαq-linked G-protein-coupled receptors (GPCRs) to cause bronchoconstriction. However, acting on the airway epithelium, such mediators may also elicit inflammatory responses. In human bronchial epithelial BEAS-2B cells (bronchial epithelium + adenovirus 12-SV40 hybrid), regulator of G-protein signaling (RGS) 2 mRNA and protein were synergistically induced in response to combinations of long-acting β2-adrenoceptor agonist (LABA) (salmeterol, formoterol) plus glucocorticoid (dexamethasone, fluticasone propionate, budesonide). Equivalent responses occurred in primary human bronchial epithelial cells. Concentrations of glucocorticoid plus LABA required to induce RGS2 expression in BEAS-2B cells were consistent with the levels achieved therapeutically in the lungs. As RGS2 is a GTPase-activating protein that switches off Gαq, intracellular free calcium ([Ca(2+)]i) flux was used as a surrogate of responses induced by histamine, methacholine, and the thromboxane receptor agonist U46619 [(Z)-7-[(1S,4R,5R,6S)-5-[(E,3S)-3-hydroxyoct-1-enyl]-3-oxabicyclo[2.2.1]heptan-6-yl]hept-5-enoic acid]. This was significantly attenuated by salmeterol plus dexamethasone pretreatment, or RGS2 overexpression, and the protective effect of salmeterol plus dexamethasone was abolished by RGS2 RNA silencing. Although methacholine and U46619 induced interleukin-8 (IL-8) release and this was inhibited by RGS2 overexpression, the repression of U46619-induced IL-8 release by salmeterol plus dexamethasone was unaffected by RGS2 knockdown. Given a role for Gαq-mediated pathways in inducing IL-8 release, we propose that RGS2 acts redundantly with other effector processes to repress IL-8 expression. Thus, RGS2 expression is a novel effector mechanism in the airway epithelium that is induced by glucocorticoid/LABA combinations. This could contribute to the efficacy of glucocorticoid/LABA combinations in asthma and COPD.
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Affiliation(s)
- Neil S Holden
- Airways Inflammation Research Group, Snyder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada (N.S.H., T.G., C.F.R., A.C., S.S., M.K., R.L., M.A.G., R.N.); GlaxoSmithKline Research and Development, Uxbridge, Middlesex, United Kingdom (M.J.); and Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, West Virginia (D.P.S.)
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31
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Kelly MM, King EM, Rider CF, Gwozd C, Holden NS, Eddleston J, Zuraw B, Leigh R, O'Byrne PM, Newton R. Corticosteroid-induced gene expression in allergen-challenged asthmatic subjects taking inhaled budesonide. Br J Pharmacol 2012; 165:1737-1747. [PMID: 21827450 DOI: 10.1111/j.1476-5381.2011.01620.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Inhaled corticosteroids (ICS) are the cornerstone of asthma pharmacotherapy and, acting via the glucocorticoid receptor (GR), reduce inflammatory gene expression. While this is often attributed to a direct inhibitory effect of the GR on inflammatory gene transcription, corticosteroids also induce the expression of anti-inflammatory genes in vitro. As there are no data to support this effect in asthmatic subjects taking ICS, we have assessed whether ICS induce anti-inflammatory gene expression in subjects with atopic asthma. EXPERIMENTAL APPROACH Bronchial biopsies from allergen-challenged atopic asthmatic subjects taking inhaled budesonide or placebo were subjected to gene expression analysis using real-time reverse transcriptase-PCR for the corticosteroid-inducible genes (official gene symbols with aliases in parentheses): TSC22D3 [glucocorticoid-induced leucine zipper (GILZ)], dual-specificity phosphatase-1 (MAPK phosphatase-1), both anti-inflammatory effectors, and FKBP5 [FK506-binding protein 51 (FKBP51)], a regulator of GR function. Cultured pulmonary epithelial and smooth muscle cells were also treated with corticosteroids before gene expression analysis. KEY RESULTS Compared with placebo, GILZ and FKBP51 mRNA expression was significantly elevated in budesonide-treated subjects. Budesonide also increased GILZ expression in human epithelial and smooth muscle cells in culture. Immunostaining of bronchial biopsies revealed GILZ expression in the airways epithelium and smooth muscle of asthmatic subjects. CONCLUSIONS AND IMPLICATIONS Expression of the corticosteroid-induced genes, GILZ and FKBP51, is up-regulated in the airways of allergen-challenged asthmatic subjects taking inhaled budesonide. Consequently, the biological effects of corticosteroid-induced genes should be considered when assessing the actions of ICS. Treatment modalities that increase or decrease GR-dependent transcription may correspondingly affect corticosteroid efficacy.
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Affiliation(s)
- M M Kelly
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - E M King
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C F Rider
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Gwozd
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - N S Holden
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J Eddleston
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - B Zuraw
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Leigh
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - P M O'Byrne
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Newton
- Airways Inflammation Research Group, Institute of Infection, Immunity and Inflammation, Faculty of Medicine, University of Calgary, Calgary, AB, CanadaAllergy and Immunology Section, University of California, San Diego School of Medicine, La Jolla, CA, USAFirestone Institute for Respiratory Health, St. Joseph's Hospital and the Department of Medicine, McMaster University, Hamilton, ON, Canada
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Cooper PR, Kurten RC, Zhang J, Nicholls DJ, Dainty IA, Panettieri RA. Formoterol and salmeterol induce a similar degree of β2-adrenoceptor tolerance in human small airways but via different mechanisms. Br J Pharmacol 2011; 163:521-32. [PMID: 21306583 DOI: 10.1111/j.1476-5381.2011.01257.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Steroids prevent and reverse salbutamol-induced β(2)-adrenoceptor tolerance in human small airways. This study examines the effects of the long-acting β(2) agonists (LABAs) formoterol and salmeterol, and the ability of budesonide to prevent desensitization. EXPERIMENTAL APPROACH Long-acting β(2) agonists in the presence and absence of budesonide were incubated with human precision-cut lung slices containing small airways. Tolerance was deduced from measurements of reduced bronchodilator responses to isoprenaline and correlated with β(2)-adrenoceptor trafficking using a virally transduced, fluorescent-tagged receptor. The ability of the LABAs to protect airways against muscarinic-induced contraction was also assessed. KEY RESULTS Following a 12 h incubation, both formoterol and salmeterol attenuated isoprenaline-induced bronchodilatation to a similar degree and these effects were not reversible by washing. Pre-incubation with budesonide prevented the desensitization induced by formoterol, but not that induced by salmeterol. Formoterol also protected the airways from carbachol-induced bronchoconstriction to a greater extent than salmeterol. In the epithelial cells of small airways, incubation with formoterol promoted receptor internalization but this did not appear to occur following incubation with salmeterol. Budesonide inhibited the formoterol-induced reduction in plasma membrane β(2)-adrenoceptor fluorescence. CONCLUSIONS AND IMPLICATIONS Although both formoterol and salmeterol attenuate isoprenaline-induced bronchodilatation, they appear to induce β(2)-adrenoceptor tolerance via different mechanisms; formoterol, but not salmeterol, enhances receptor internalization. Budesonide protection against β(2)-adrenoceptor tolerance was correlated with the retention of receptor fluorescence on the plasma membrane, thereby suggesting a mechanism by which steroids alter β(2)-adrenoceptor function.
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Affiliation(s)
- P R Cooper
- Department of Medicine, Airway Biology Initiative, University of Pennsylvania School of Medicine, Philadelphia, USA
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Black PN, Sexton PM. Budesonide and risk of pneumonia. Lancet 2009; 374:2050-2051. [PMID: 20109825 DOI: 10.1016/s0140-6736(09)62145-0] [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] [Indexed: 10/20/2022]
Affiliation(s)
- Peter N Black
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Paul M Sexton
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Naikwade SR, Bajaj AN, Gurav P, Gatne MM, Singh Soni P. Development of budesonide microparticles using spray-drying technology for pulmonary administration: design, characterization, in vitro evaluation, and in vivo efficacy study. AAPS PharmSciTech 2009; 10:993-1012. [PMID: 19649711 DOI: 10.1208/s12249-009-9290-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 07/02/2009] [Indexed: 11/30/2022] Open
Abstract
The purpose of this research was to generate, characterize, and investigate the in vivo efficacy of budesonide (BUD) microparticles prepared by spray-drying technology with a potential application as carriers for pulmonary administration with sustained-release profile and improved respirable fraction. Microspheres and porous particles of chitosan (drug/chitosan, 1:2) were prepared by spray drying using optimized process parameters and were characterized for different physicochemical parameters. Mass median aerodynamic diameter and geometric standard deviation for conventional, microspheres, and porous particles formulations were 2.75, 4.60, and 4.30 microm and 2.56, 1.75, and 2.54, respectively. Pharmacokinetic study was performed in rats by intratracheal administration of either placebo or developed dry powder inhalation (DPI) formulation. Pharmacokinetic parameters were calculated (Ka, Ke, T(max), C(max), AUC, and Vd) and these results indicated that developed formulations extended half life compared to conventional formulation with onefold to fourfold improved local and systemic bioavailability. Estimates of relative bioavailability suggested that developed formulations have excellent lung deposition characteristics with extended T(1/2) from 9.4 to 14 h compared to conventional formulation. Anti-inflammatory activity of BUD and developed formulations was compared and found to be similar. Cytotoxicity was determined in A549 alveolar epithelial cell line and found to be not toxic. In vivo pulmonary deposition of developed conventional formulation was studied using gamma scintigraphy and results indicated potential in vitro-in vivo correlation in performance of conventional BUD DPI formulation. From the DPI formulation prepared with porous particles, the concentration of BUD increased fourfold in the lungs, indicating pulmonary targeting potential of developed formulations.
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Kelly HW. Comparison of inhaled corticosteroids: an update. Ann Pharmacother 2009; 43:519-27. [PMID: 19261959 DOI: 10.1345/aph.1l546] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the basis for the estimated comparative daily dosages of inhaled corticosteroids for children and adults that are presented in the National Heart, Lung, and Blood Institute's Expert Panel Report 3; in addition, the pharmacodynamic and pharmacokinetic basis for potential clinical differences among inhaled corticosteroids is discussed. DATA SOURCES A complete MEDLINE search was conducted of human studies of asthma pharmacotherapy published between January 1, 2001, and March 15, 2006, followed by a PubMed search up until August 2008, using ciclesonide, inhaled corticosteroids, and pharmacokinetics as key words. Product information on each inhaled corticosteroid was also included. STUDY SELECTION AND DATA EXTRACTION Comparative clinical trials of inhaled corticosteroids and systematic reviews for efficacy comparisons were evaluated. Extensive literature reviews, meta-analyses, and selected clinical studies that illustrate or represent specific points of view were selected. Pharmacodynamic and pharmacokinetic data extracted from previously published reviews and specific studies were included. DATA SYNTHESIS Pharmacodynamic characteristics (glucocorticoid receptor binding) and lung delivery determine the relative clinical efficacy and pharmacokinetic properties (oral bioavailability, lung retention, systemic clearance) and determine comparative therapeutic index of the inhaled corticosteroids. Secondary pharmacokinetic differences (intracellular fatty acid esterification, high serum protein binding) that have been posited to improve duration of action and/or therapeutic index are unproven, and current comparative clinical trials do not support the hypotheses that they provide an advantage. Ultrafine particle meter-dose inhalers (MDIs) have not demonstrated superior asthma control or improved safety over older MDIs. All of the inhaled corticosteroids demonstrate efficacy with once-daily dosing, and all are more effective when dosed twice daily. CONCLUSIONS Current evidence suggests that all of the inhaled corticosteroids have sufficient therapeutic indexes to provide similar efficacy and safety in low to medium doses. Whether or not some of the newer inhaled corticosteroids offer any advantages at higher doses has yet to be determined.
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Affiliation(s)
- H William Kelly
- University of New Mexico Health Sciences Center, Children's Hospital of New Mexico, 2211 Lomas Blvd. NE, Albuquerque, NM 87131, USA.
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