1
|
Tantilipikorn P, Kirtsreesakul V, Bunnag C, Vangveeravong M, Thanaviratananich S, Chusakul S. The Use of Azelastine Hydrochloride/Fluticasone Propionate in the Management of Allergic Rhinitis in Asia: A Review. J Asthma Allergy 2024; 17:667-679. [PMID: 39045291 PMCID: PMC11264124 DOI: 10.2147/jaa.s451733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/13/2024] [Indexed: 07/25/2024] Open
Abstract
The incidence of allergic rhinitis (AR) in Asia and the world is steadily rising. Patients experience incomplete symptom relief despite existing treatment options, which warrants the need for new therapeutic regimes. Azelastine hydrochloride/fluticasone propionate (MP-AzeFlu), a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate has been indicated in the treatment of AR. The current review discusses the effects of MP-AzeFlu versus conventional therapies in achieving superior clinical improvement with a very rapid onset of action (5 minutes). The superiority of MP-AzeFlu in offering complete symptom control with sustained relief in patients with AR compared to the existing therapeutic options is also discussed. MP-AzeFlu has been shown to improve the quality of life for patients with AR, thereby enhancing patient adherence to therapy and establishing its preference for the treatment of AR. Currently, the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines recommend the use of a combination of intranasal corticosteroids and intranasal antihistamines as first-line treatment in patients with persistent AR with visual analog scores ≥5 or when prior treatment with single agents has been ineffective. Widely published data on the efficacy and safety of its prolonged use in adults and children have validated that effective treatment of AR can be achieved with MP-AzeFlu.
Collapse
Affiliation(s)
- Pongsakorn Tantilipikorn
- Center of Research Excellence in Allergy & Immunology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chaweewan Bunnag
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Supinda Chusakul
- Department of Otolaryngology, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
2
|
Qi W, Liu Y, Xue W, Li K, Gorski JC, Liu M, Yan T, Nguyen DT, Ramalingam RK. The Comparative Bioavailability of Fluticasone and Azelastine Delivered as a Single Fixed Dose Combination (MP-AzeFlu) in Comparison to Two Different Formulations of Azelastine and Fluticasone Propionate Following Intranasal Administration in Healthy Chinese Volunteers. J Asthma Allergy 2023; 16:667-677. [PMID: 37409000 PMCID: PMC10319279 DOI: 10.2147/jaa.s416095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Two studies (Study I and Study II) were conducted in healthy Chinese volunteers to confirm that there was no pharmacokinetic drug interaction between AZE and FLU in MP-AzeFlu. The secondary objective was to evaluate the pharmacokinetic parameters of MP-AzeFlu compared with the commercially available mono-components. Methods Both studies were a randomized, open-label, three-period, six-sequence, single-dose cross-over trial (William's design) conducted at Beijing Hospital (Beijing, China) in September and October of 2019 in 30 healthy adult male and female volunteers. The natural log transformed parameters: AUC0-tlast, AUC0-∞ and Cmax were analyzed. Results The comparison of PK parameters between MP-AzeFlu and Aze (commercially available) showed that the LS mean ratios (90% CI) values for, AUC0-tlast, AUC 0-∞ and Cmax were 100.29% (94.31-106.66%), 100.76% (94.60-107.32%) and 93.14% (81.47-106.48%). The comparison of PK parameters between MP-AzeFlu and Flu (commercially available) for the bioavailability evaluation showed that the LS mean ratios (90% CI) values for, AUC0-tlast, AUC 0-∞ and Cmax were 83.48% (69.81-99.82%), 100.19% (87.34-114.94%) and 81.91% (68.50-97.95%). Conclusion The study results confirm that neither the FLU or the AZE component in the combination product (MP-AzeFlu), nor the existing qualitative and quantitative differences in the formulation between the currently marketed AZE and FLU mono-product, display significant potential to impact the systemic exposure of AZE or FLU in Chinese subjects.
Collapse
Affiliation(s)
- Wenyuan Qi
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yue Liu
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Wei Xue
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Kexin Li
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - J Christopher Gorski
- Global Clinical Pharmacology, Mylan Pharmacetical Inc. (Now Viatris), Morgantown, WV, USA
| | - Mark Liu
- Global Clinical Pharmacology, Mylan Pharmacetical Inc. (Now Viatris), Morgantown, WV, USA
| | - Tieliang Yan
- Global Clinical Pharmacology, Mylan Pharmacetical Inc. (Now Viatris), Morgantown, WV, USA
| | - Duc Tung Nguyen
- Global Clinical Sciences, MEDA Pharma GmbH & Co. KG (A Viatris Company), Bad-Homburg, Germany
| | - Rajesh Kumar Ramalingam
- Global Medical Affairs, Mylan Pharmaceuticals Private Limited (Now Viatris), Bengaluru, India
| |
Collapse
|
3
|
Applicability of RPMI 2650 and Calu-3 Cell Models for Evaluation of Nasal Formulations. Pharmaceutics 2022; 14:pharmaceutics14020369. [PMID: 35214101 PMCID: PMC8877043 DOI: 10.3390/pharmaceutics14020369] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 02/05/2023] Open
Abstract
The RPMI 2650 and Calu-3 cell lines have been previously evaluated as models of the nasal and airway epithelial barrier, and they have demonstrated the potential to be used in drug permeation studies. However, limited data exist on the utilization of these two cell models for the assessment of nasal formulations. In our study, we tested these cell lines for the evaluation of in vitro permeation of intranasally administered drugs having a local and systemic effect from different solution- and suspension-based formulations to observe how the effects of formulations reflect on the measured in vitro drug permeability. Both models were shown to be sufficiently discriminative and able to reveal the effect of formulation compositions on drug permeability, as they demonstrated differences in the in vitro drug permeation comparable to the in vivo bioavailability. Good correlation with the available bioavailability data was also established for a limited number of drugs formulated as intranasal solutions. The investigated cell lines can be applied to the evaluation of in vitro permeation of intranasally administered drugs with a local and systemic effect from solution- and suspension-based formulations.
Collapse
|
4
|
Yum HY, Ha EK, Shin YH, Han MY. Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis. Clin Exp Pediatr 2021; 64:373-383. [PMID: 32777916 PMCID: PMC8342874 DOI: 10.3345/cep.2020.00822] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%-89% of the chronic rhinitis cases, affecting 1%-50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. Here, we aimed to estimate the rate of coexisting comorbidities of nonallergic rhinitis. Nonallergic rhinitis is more prevalent during the first 2 years of life; however, its underestimation for children with atopic tendencies is likely due to low positive rates of specific allergic tests during early childhood. Local allergic rhinitis is a recently noted phenotype with rates similar to those in adults (median, 44%; range, 4%-67%), among patients previously diagnosed with nonallergic rhinitis. Idiopathic rhinitis, a subtype of nonallergic rhinitis, has been poorly studied in children, and its rates are known to be lower than those in adults. The prevalence of nonallergic rhinitis with eosinophilia syndrome is even lower. A correlation between nonallergic rhinitis and pollution has been suggested owing to the recent increase in nonallergic rhinitis rates in highly developing regions such as some Asian countries, but many aspects remain unknown. Conventional treatments include antihistamines, intranasal corticosteroids, and recent treatments include combination of intranasal corticosteroids with azelastin or decongestants. Here we review the prevalence, diagnosis, comorbidities, and treatment recommendations for nonallergic rhinitis versus allergic rhinitis in children.
Collapse
Affiliation(s)
- Hye Yung Yum
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yoon Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
5
|
Fowler J, Rotenberg BW, Sowerby LJ. The subtle nuances of intranasal corticosteroids. J Otolaryngol Head Neck Surg 2021; 50:18. [PMID: 33731223 PMCID: PMC7968222 DOI: 10.1186/s40463-020-00480-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/16/2020] [Indexed: 01/31/2024] Open
Abstract
Background In the specialty of Otolaryngology – Head and Neck Surgery, intranasal corticosteroids are the mainstay treatment for inflammatory processes within the nasal cavity. All too often, physician prescribing patterns are based on previous training, personal experience, and interactions with industry. The purpose of this commentary is to review the nuances of each intranasal corticosteroid. Commentary There are nine intranasal corticosteroids approved for use in Canada. Each are discussed in detail, including their indication, bioavailability, effects on intranasal environment, and factors around patient adherence. Off-label use of budesonide irrigations is also discussed and cost information is presented in reference format for all available intranasal corticosteroids. Conclusion Although the efficacy of each intranasal corticosteroid has been shown to be similar, prescribing should be tailored based on bioavailability, intranasal environment, and factors that impact patient adherence such as dosing, cost and tolerability. Graphical abstract ![]()
Collapse
Affiliation(s)
- James Fowler
- Department of Otolaryngology - Head and Neck Surgery, Western University, 3St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, 3St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, 3St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
| |
Collapse
|
6
|
Reznikov LR, Norris MH, Vashisht R, Bluhm AP, Li D, Liao YSJ, Brown A, Butte AJ, Ostrov DA. Identification of antiviral antihistamines for COVID-19 repurposing. Biochem Biophys Res Commun 2021; 538:173-179. [PMID: 33309272 PMCID: PMC7713548 DOI: 10.1016/j.bbrc.2020.11.095] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
There is an urgent need to identify therapies that prevent SARS-CoV-2 infection and improve the outcome of COVID-19 patients. Although repurposed drugs with favorable safety profiles could have significant benefit, widely available prevention or treatment options for COVID-19 have yet to be identified. Efforts to identify approved drugs with in vitro activity against SARS-CoV-2 resulted in identification of antiviral sigma-1 receptor ligands, including antihistamines in the histamine-1 receptor binding class. We identified antihistamine candidates for repurposing by mining electronic health records of usage in population of more than 219,000 subjects tested for SARS-CoV-2. Usage of diphenhydramine, hydroxyzine and azelastine was associated with reduced incidence of SARS-CoV-2 positivity in subjects greater than age 61. We found diphenhydramine, hydroxyzine and azelastine to exhibit direct antiviral activity against SARS-CoV-2 in vitro. Although mechanisms by which specific antihistamines exert antiviral effects is not clear, hydroxyzine, and possibly azelastine, bind Angiotensin Converting Enzyme-2 (ACE2) and the sigma-1 receptor as off-targets. Clinical studies are needed to measure the effectiveness of diphenhydramine, hydroxyzine and azelastine for disease prevention, for early intervention, or as adjuvant therapy for severe COVID-19.
Collapse
Affiliation(s)
- Leah R Reznikov
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL, USA
| | - Michael H Norris
- Department of Geography and the Emerging Pathogens Institute, Spatial Epidemiology and Ecology Research Laboratory, University of Florida, Gainesville, FL, USA
| | - Rohit Vashisht
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - Andrew P Bluhm
- Department of Geography and the Emerging Pathogens Institute, Spatial Epidemiology and Ecology Research Laboratory, University of Florida, Gainesville, FL, USA
| | - Danmeng Li
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Yan-Shin J Liao
- Department of Physiological Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL, USA
| | - Ashley Brown
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA
| | - David A Ostrov
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
7
|
Berger WE, Bachert C, Allara R, Koltun A, Kopietz F, Maus JG, D'Addio AD. Evaluation of in vitro Penetration of Fluticasone Propionate from MP-AzeFlu and Fluticasone Propionate Nasal Spray Through EpiAirway™606 Tissues Using Vertical Diffusion Cells. J Asthma Allergy 2020; 13:187-192. [PMID: 32547111 PMCID: PMC7266522 DOI: 10.2147/jaa.s238421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Most patients with allergic rhinitis (AR) have moderate-to-severe disease, requiring complete and prompt relief when symptoms occur. The time course of fluticasone propionate (FP) penetration into nasal tissues after intranasal administration is not well characterized. The goal of this proof-of-concept study was to evaluate the mucosal penetration of FP from fixed-combination FP-azelastine nasal spray (MP-AzeFlu) compared with an FP-only nasal spray in an in vitro, 3-dimensional human bronchial tissue model. Materials and Methods Absorption of FP from MP-AzeFlu and FP nasal spray was modeled using EpiAirway™606 (MatTek Corporation; Ashland, MA, USA) tissue cultured in vertical diffusion cells. The dosing amount of MP-AzeFlu was optimized in a pilot study. Based on the results of the pilot study, 10 µL of MP-AzeFlu (3.65 µg; n = 8) and 10 µL of FP nasal spray (5.00 µg; n = 8) were evaluated for penetration of tissue. Tissue integrity was monitored with Lucifer yellow. FP in the receiving media was quantified for each sample using liquid chromatography with tandem mass spectrometry. Results MP-AzeFlu and FP nasal spray were associated with similar FP accumulation profiles in the receiving media, but the permeability of FP was greater for MP-AzeFlu during hours 0 to 6, suggesting faster absorption for MP-AzeFlu. No indications of compromised tissue integrity were found in any of the tested cells. Conclusion The higher and more rapid penetration of FP from MP-AzeFlu supports the use of MP-AzeFlu for patients with AR, particularly when prioritizing fast and pronounced symptom relief.
Collapse
Affiliation(s)
- William E Berger
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA, USA
| | | | | | | | | | - Joachim G Maus
- Meda Pharma GmbH & Co. KG (a Mylan Company), Bad Homburg, Germany
| | | |
Collapse
|
8
|
Bjermer L, Westman M, Holmström M, Wickman MC. The complex pathophysiology of allergic rhinitis: scientific rationale for the development of an alternative treatment option. Allergy Asthma Clin Immunol 2019; 15:24. [PMID: 31015846 PMCID: PMC6469109 DOI: 10.1186/s13223-018-0314-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/20/2018] [Indexed: 01/27/2023] Open
Abstract
Allergic rhinitis (AR) poses a global health problem and can be challenging to treat. Many of the current symptomatic treatments for AR have been available for decades, yet there has been little improvement in patient quality of life or symptom burden over the years. In this review, we ask why this might be and explore the pathophysiological gaps that exist within the various AR treatment classes. We focus on the benefits and drawbacks of different treatment options and delivery routes for AR treatments and consider how, given what is known about AR pathophysiology and symptomatology, patients may be offered more effective treatment options for rapid, effective, and sustained AR control. In particular, we consider how a new AR preparation, MP-AzeFlu (Dymista®, Meda, Sweden), comprising a formulation of an intranasal antihistamine (azelastine hydrochloride), an intranasal corticosteroid (fluticasone propionate), and excipients delivered in a single spray, may offer benefits over and above single and multiple AR therapy options. We review the evidence in support of this treatment across the spectrum of AR disease. The concept of AR control is also reviewed within the context of new European Union and Contre les Maladies Chroniques pour un VIeillissement Actif-Allergic Rhinitis and its Impact on Asthma initiatives.
Collapse
Affiliation(s)
- Leif Bjermer
- 1Department of Respiratory Medicine & Allergology, Skane University Hospital, 22185, Lund, Sweden
| | - Marit Westman
- 2Dept. of ENT-diseases, Karolinska University Hospital, 171 76 Stockholm, Sweden.,3Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mats Holmström
- 4Dept. of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Magnus C Wickman
- 5Department of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.,Sach's Children's Hospital, 118 83 Stockholm, Sweden
| |
Collapse
|
9
|
Linking Suspension Nasal Spray Drug Deposition Patterns to Pharmacokinetic Profiles: A Proof-of-Concept Study Using Computational Fluid Dynamics. J Pharm Sci 2017; 105:1995-2004. [PMID: 27238495 DOI: 10.1016/j.xphs.2016.03.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/15/2016] [Accepted: 03/25/2016] [Indexed: 11/22/2022]
Abstract
The objective of this study was to link regional nasal spray deposition patterns of suspension formulations, predicted with computational fluid dynamics, to in vivo human pharmacokinetic plasma concentration profiles. This is accomplished through the use of computational fluid dynamics simulations coupled with compartmental pharmacokinetic modeling. Results showed a rapid initial rise in plasma concentration that is due to the absorption of drug particles deposited in the nasal middle passages, followed by a slower increase in plasma concentration that is governed by the transport of drug particles from the nasal vestibule to the middle passages. Although drug deposition locations in the nasal cavity had a significant effect on the shape of the concentration profile, the absolute bioavailability remained constant provided that all the drug remained in the nose over the course of the simulation. Loss of drug through the nostrils even after long periods resulted in a significant decrease in bioavailability and increased variability. The results of this study quantify how differences in nasal drug deposition affect transient plasma concentrations and overall bioavailability. These findings are potentially useful for establishing bioequivalence for nasal spray devices and reducing the burden of in vitro testing, pharmacodynamics, and clinical studies.
Collapse
|
10
|
Dollner R, Lorentz Larsen P, Dheyauldeen S, Steinsvåg S. A multicenter, prospective, noninterventional study in a Norwegian cohort of patients with moderate-to-severe allergic rhinitis treated with MP-AzeFlu. ALLERGY & RHINOLOGY 2017; 8:148-156. [PMID: 29070272 PMCID: PMC5662540 DOI: 10.2500/ar.2017.8.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Allergic Rhinitis and its Impact on Asthma guidelines recently recommended a treatment strategy for allergic rhinitis (AR) based on disease control rather than symptom severity by using a visual analog scale (VAS) to categorize control. Objectives: To evaluate the effectiveness of MP-AzeFlu (Dymista®) by using this VAS in routine clinical practice in Norway. MP-AzeFlu comprises a novel formulation that contains azelastine hydrochloride, fluticasone propionate and excipients delivered in a single spray. Methods: This multicenter, prospective, noninterventional study enrolled patients (n = 160) with moderate-to-severe AR and acute symptoms who were eligible to receive treatment with MP-AzeFlu according to its summary of product characteristics. Patients assessed symptom severity by using a VAS from 0 (not at all bothersome) to 100 mm (very bothersome) in the morning before MP-AzeFlu use on days 0, 1, 3, 7, and after ∼14 days. On day 3, the patients assessed their level of disease control as well controlled, partly controlled, or uncontrolled. The proportion of Norwegian patients who achieved defined VAS score cutoffs for “well-controlled” and “partly controlled” AR were also calculated. Results: MP-AzeFlu reduced the mean ± standard deviation VAS score from 68.1 ± 16.4 mm at baseline to 37.4 ± 25.9 mm on the last day, a reduction of 30.8 ± 27.2 mm. The results were consistent, irrespective of disease severity, phenotype (i.e., seasonal AR [SAR], perennial AR [PAR], SAR plus PAR, unknown) or age (i.e., 12–17, 18–65, and >65 years). Of the patients (with recorded data), 88.1% considered their symptoms to be partly or well controlled at day 3; and 19.5, 32.0, 50.0, and 61.0% of the patients achieved a ≤38 mm well-controlled VAS score cutoff on days 1, 3, 7, and the last day, respectively. Conclusions: MP-AzeFlu provided rapid sustained symptom control in a routine clinical practice in Norway, which provided support for its effectiveness for the treatment of AR in real life.
Collapse
Affiliation(s)
- Ralph Dollner
- From the Department of Otorhinolaryngology, Division of Head, Neck and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Sinan Dheyauldeen
- From the Department of Otorhinolaryngology, Division of Head, Neck and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Sverre Steinsvåg
- Sørlandet Hospital, Department of Otolaryngology, Head and Neck Surgery, Kristiansand, Norway
| |
Collapse
|
11
|
Klimek L, Mullol J, Hellings P, Gevaert P, Mösges R, Fokkens W. Recent pharmacological developments in the treatment of perennial and persistent allergic rhinitis. Expert Opin Pharmacother 2016; 17:657-69. [PMID: 26800187 DOI: 10.1517/14656566.2016.1145661] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) has a major negative impact on patients' quality of life (QoL) and carries a high socio economic burden. This is particularly the case for patients who experience symptoms for extended periods of time (i.e. those with perennial (PAR) or persistent AR (PER), depending on the classification system used). This review covers available pharmacological advances and recent developments in the treatment of PAR or PER. AREAS COVERED Pharmacological AR treatment is used to reduce symptom burden and help restore patients' normal daily routine. Traditionally, non-sedating antihistamines and intranasal corticosteroids (INS) were the two drug classes recommended for use first line. These, along with antileukotrienes, decongestants, mast cell stabilizers and anticholinergics, constituted the bulk of the AR treatment arsenal. MP-AzeFlu (Dymista®, Meda, Solna, Sweden) is the most recent addition to that arsenal. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray and has surpassed available therapies in terms of symptom control and treatment response. Other relatively new treatments for PAR or PER include H3 antihistamines, toll-like receptor (TLR) agonists, cellulose powders and micro-emulsions, novel biomolecular formulations and omalizumab. Each of these new additions is reviewed here. EXPERT OPINION A new AR drug class has recently been introduced (i.e. RO1AD58). Currently MP-AzeFlu is the only treatment option within this drug class. It can be estimated that combination treatments like MP-AzeFlu will become the mainstay of PAR and PER therapy since use will result in better compliance, improved efficacy over INS and a faster response together with good levels of tolerability. The challenge is to find other equally, or more effective, combination treatments, as has been the therapeutic standard in bronchial asthma for decades. The potential of biologics, as well as TLR-agonists and other new treatment options needs to be further evaluated.
Collapse
Affiliation(s)
- Ludger Klimek
- a Center for Rhinology and Allergology , Wiesbaden , Germany
| | - Joaquim Mullol
- b Clinical and Experimental Respiratory Immunoallergy, IDIBAPS; Rhinology and Smell Clinic, ENT Department , Hospital Clínic , Barcelona , Spain
| | - Peter Hellings
- c Laboratory of Clinical Immunology , University Hospitals Leuven , Leuven , Belgium
| | - Philippe Gevaert
- d Upper Airways Research Laboratory, Department of Otorhinolaryngology , Ghent University Hospital , Ghent , Belgium
| | - Ralph Mösges
- e Institute of Medical Statistics , Informatics and Epidemiology (IMSIE) , Cologne , Germany
| | - Wytske Fokkens
- f Department of Otorhinolaryngology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| |
Collapse
|
12
|
Klimek L, Demoly P, Price D. Effectiveness of allergic rhinitis treatments in real-life with a focus on MP-AzeFlu. Expert Rev Clin Pharmacol 2016; 9:705-14. [PMID: 26839083 DOI: 10.1586/17512433.2016.1148598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For any allergic rhinitis (AR) treatment, it is crucial to provide evidence not only of efficacy (assessed in randomized controlled trials (RCTs)) but also of effectiveness in real-life. Observational studies provide valuable data on the use and results associated with interventions prescribed in real-life. However, real-life evidence supporting available AR treatment options is sparse with effectiveness only established for oral antihistamines (desloratadine, ebastine), intranasal corticosteroids (mometasone furoate, fluticasone propionate (FP)), allergen immunotherapy and omalizumab. A novel intranasal formulation of azelastine hydrochloride and FP in a single spray (MP-AzeFlu) shows great promise, with the effectiveness observed in real-life exceeding that noted in RCTs. This review summarises real-life data on MP-AzeFlu, which provides rapid and sustained symptom control irrespective of patient age, AR phenotype or disease severity. We call for high quality real-life research in addition to RCTs to inform future AR treatment guidelines.
Collapse
Affiliation(s)
- Ludger Klimek
- a Center for Rhinology and Allergology , Wiesbaden , Germany
| | - Pascal Demoly
- b Département de Pneumologie et Addictologie , University Hospital of Montpellier , Montpellier , France
| | - David Price
- c Division of Applied Health Sciences , University of Aberdeen , Aberdeen , UK
| |
Collapse
|
13
|
Klimek L, Bousquet J, Price D. Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis. Expert Opin Drug Saf 2015; 15:117-29. [PMID: 26581312 DOI: 10.1517/14740338.2016.1122755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION As a chronic disease, allergic rhinitis (AR) requires regular use of allergy medications for the effective management of symptoms. It is therefore imperative that AR treatments not only provide adequate symptom control but are also well tolerated. AREAS COVERED MP29-02 (Dymista, Meda, Solna, Sweden) is the first new class of AR medication (WHO ATC R01AD58) since the introduction of intranasal corticosteroids (INS) almost 50 years ago. It is a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate delivered in a single spray. Here we review all the safety information relevant to MP29-02, from the initial phase I bioavailability and disposition data, to the phase III 14-day and 52-week data and finally to phase IV safety data collected during MP29-02 use in routine clinical practice. EXPERT OPINION MP29-02 is the first real therapeutic advance in AR since the introduction of INS and has the potential to change the way this disease is managed, simplifying AR treatment regimens to a single puff in each nostril twice a day. Patients will benefit from superior symptom relief MP29-02 compared to INS with the added assurance that the safety of MP29-02 has been confirmed in the short term and long term as well as in real life.
Collapse
Affiliation(s)
- Ludger Klimek
- a Department of Otorhinolaryngology , Zentrum für Rhinologie und Allergologie , An den Quellen 10 D-65183 , Wiesbaden , Germany
| | - Jean Bousquet
- b Department of Pneumology , University of Montpellier - Hopital Arnaud de Villeneuve , Montpellier , France
| | - David Price
- c General Practice Airways Group Professor of Primary Care Respiratory Medicine, Department of General Practice and Primary Care, Foresterhill Health Centre , University of Aberdeen , Westburn Road, Aberdeen AB25 2AY , UK
| |
Collapse
|
14
|
Azelastine hydrochloride/fluticasone propionate combined in a single nasal spray: a guide to its use in allergic rhinitis. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
15
|
Concomitant corticosteroid nasal spray plus antihistamine (oral or local spray) for the symptomatic management of allergic rhinitis. Eur Arch Otorhinolaryngol 2015; 273:3477-3486. [DOI: 10.1007/s00405-015-3832-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022]
|
16
|
Canonica GW, Triggiani M, Senna G. 360 degree perspective on allergic rhinitis management in Italy: a survey of GPs, pharmacists and patients. Clin Mol Allergy 2015; 13:25. [PMID: 26528081 PMCID: PMC4629286 DOI: 10.1186/s12948-015-0029-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND General practitioners (GPs), community pharmacists and allergic rhinitis (AR) patients in Italy were surveyed in order to gain insight from all three perspectives into the diagnosis, management and burden of AR in Italy. METHODS General practitioners and pharmacists (n = 100 for each) were surveyed by telephone; questions related to overall practice and to last AR patient seen. Patients (n = 552) completed a questionnaire after visiting specialist allergy centres. Questions related to diagnosis and treatment, degree of everyday limitation from AR, and satisfaction with treatment. The data were analysed descriptively. RESULTS Allergic rhinitis was managed mainly by GPs, who reported making the diagnosis themselves in 68 % of cases; rhinorrhea (64 %), sneezing (57 %) and congestion (49 %) were the symptoms most frequently taken into account. Limitation from AR on everyday life was rated 6.2 out of 10 by GPs. Pharmacists most often considered eye tearing (54 %) in their diagnosis. Almost half of GPs (49 %) and 87 % of pharmacists were unaware of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The most commonly reported prescribed treatments by GPs were branded mometasone furoate, desloratadine, ebastine and generic mometasone; 21 % prescribed homeopathic products occasionally. On average, GPs remembered that their last patient case had moderate/severe disease, was prescribed anti-histamine monotherapy (37 % of cases), and did not change prescription (78 %). Pharmacists recommended an antihistamine for 56 % of clients who asked for advice, and a nasal decongestant for 21 %. Patients rated limitation from AR on everyday life as 5.7/10. 55 % reported using multiple therapies, and 43 % were not satisfied or weakly satisfied with their current treatment. Patients' main expectation for the future was to succeed in managing their AR symptoms (45 %), while 22 % hoped for a definitive cure. Many patients (61 %) were concerned their health would deteriorate. CONCLUSIONS Allergic rhinitis is largely managed by GPs in Italy, with pharmacists also playing a role, yet awareness of the ARIA guidelines among these groups is low. Patient satisfaction with treatment is moderate or low. New more effective treatments are needed to improve AR management in Italy. Allergy education programs need to be better targeted to GPs and pharmacists, and communication with patients regarding symptom control must be improved.
Collapse
Affiliation(s)
- G Walter Canonica
- Respiratory and Allergy Clinic, DIMI-Department of Internal Medicine, University of Genoa, IRCCS Aou San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | | |
Collapse
|
17
|
Rossi O, Massaro I, Caminati M, Quecchia C, Fassio F, Heffler E, Canonica GW. Escaping the trap of allergic rhinitis. Clin Mol Allergy 2015; 13:17. [PMID: 26244040 PMCID: PMC4524393 DOI: 10.1186/s12948-015-0023-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/18/2015] [Indexed: 01/03/2023] Open
Abstract
Rhinitis is often the first symptom of allergy but is frequently ignored and classified as a nuisance condition. Ironically it has the greatest socioeconomic burden worldwide caused by its impact on work and on daily life. However, patients appear reticent to seek professional advice, visiting their doctor only when symptoms become ‘intolerable’ and often when their usual therapy proves ineffective. Clearly, it’s time for new and more effective allergic rhinitis treatments. MP29-02 (Dymista®; Meda, Solna, Sweden) is a new class of medication for moderate to severe seasonal and perennial allergic rhinitis if monotherapy with either intranasal antihistamine or intranasal corticosteroids is not considered sufficient. MP29-02 is a novel formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP). It benefits not only from the incorporation of two active agents, but also from a novel formulation; its lower viscosity, smaller droplet size, larger volume (137 μl) and wider spray angle ensure optimal coverage of, and retention on the nasal mucosa and contribute to its clinical efficacy. In clinical trials, patients treated with MP29-02 experienced twice the symptom relief as those treated with FP and AZE, who in turn exhibited significantly greater symptom relief than placebo-patients. Indeed, the advantage of MP29-02 over FP was approximately the same as that shown for FP over placebo. The advantage of MP29-02 was particularly evident in those patients for whom nasal congestion is predominant, with MP29-02 providing three times the nasal congestion relief of FP (p = 0.0018) and five times the relief of AZE (p = 0.0001). Moreover, patients treated with MP29-02 achieved each and every response up to a week faster than those treated with FP or AZE alone and in real life 1 in 2 patients reported the perception of well-controlled disease after only 3 days. MP29-02’s superiority over FP was also apparent long-term in patients with perennial allergic rhinitis or non-allergic rhinitis, with statistical significance noted from the first day of treatment, with treatment difference maintained for a full year. Taken together, these data suggest that MP29-02 may improve the lives of many of our patients, enabling them to finally escape the allergic rhinitis trap.
Collapse
Affiliation(s)
- Oliviero Rossi
- Allergy Unit, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 1, 50129 Firenze, Italy
| | | | - Marco Caminati
- Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Cristina Quecchia
- Allergy Unit, Melegnano Hospital, Melegnano (Milano), Italy and Clinical Pedagogical Laboratory and Biomedical Research, Pediatric Hospital, Brescia, Italy
| | | | - Enrico Heffler
- Respiratory Medicine and Allergy - Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giorgio Walter Canonica
- Respiratory Diseases & Allergy Clinic, DIMI-Department Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genoa, IRCCS AOU S. Martino Genoa, Genoa, Italy
| |
Collapse
|
18
|
A role for the intranasal formulation of azelastine hydrochloride/fluticasone propionate in the treatment of allergic rhinitis. Ther Deliv 2015; 6:653-9. [PMID: 25913181 DOI: 10.4155/tde.15.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rhinitis is a very common disease and represents a health problem for both children and adults globally. Rhinitis can be allergic or occur without any IgE-mediated sensitization to aeroallergens. Common symptoms include nasal congestion, postnasal drainage, nasal itching, rhinorrhea and sneezing. The most effective drugs for the treatment of rhinitis are antihistamines and topical glucocorticoids. MP29-02 (Dymista(®)) is a novel intranasal formulation combining the second-generation antihistamine, azelastine hydrochloride, with fluticasone propionate in a single device that has recently been developed. Here, we review the efficacy and safety profile of this intranasal formulation in the treatment of allergic and nonallergic rhinitis.
Collapse
|
19
|
Bousquet J, Bachert C, Bernstein J, Canonica GW, Carr W, Dahl R, Demoly P, Devillier P, Hellings P, Fokkens W, Klimek L, Lieberman P, Meltzer E, Price D, Ryan D, Wahn U. Advances in pharmacotherapy for the treatment of allergic rhinitis; MP29-02 (a novel formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) fills the gaps. Expert Opin Pharmacother 2015; 16:913-28. [PMID: 25747125 DOI: 10.1517/14656566.2015.1020789] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Effective pharmacologic treatment exists for most patients suffering from allergic rhinitis (AR). However, both in clinical trials and in real-life studies, many patients are dissatisfied with treatment. Physicians often use multiple therapies, in an attempt to improve symptom control, often with limited evidence of success. Novel treatment options are needed and must consider unmet medical needs. AREAS COVERED This article reviews the clinical data for a new AR treatment. MP29-02 (Dymista®, Meda, Solna, Sweden) contains azelastine hydrochloride (AZE) and fluticasone propionate (FP), in a novel formulation and delivered in an improved device as a single nasal spray. It has shown superior efficacy in AR patients than either commercially available AZE or FP monotherapy for both nasal and ocular symptom relief, regardless of disease severity. MP29-02 also provided more effective and rapid symptom relief than either AZE or FP monotherapy delivered in the MP29-02 formulation and device. However, the effect was less than that observed versus commercial comparators, suggesting the impact of formulation and device on clinical efficacy. EXPERT OPINION MP29-02 simplifies AR management, surpassing the efficacy of gold standard treatment, intranasal corticosteroids (INS), for the first time. It is indicated for the treatment of moderate-to-severe seasonal allergic rhinitis and perennial allergic rhinitis when monotherapy with either intranasal antihistamine or INS is NOT considered sufficient. Most patients present with moderate/severe disease, with evidence of current or previous treatment insufficiency. MP29-02 should be the treatment of choice for these patients.
Collapse
Affiliation(s)
- Jean Bousquet
- Hopital Arnaud de Villeneuve University Hospital and Inserm , Montpellier CSP1018 , France +33 467336105 ; +33 467416702 ;
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Ridolo E, Montagni M, Melli V, Braido F, Incorvaia C, Canonica GW. Pharmacotherapy of allergic rhinitis: current options and future perspectives. Expert Opin Pharmacother 2013; 15:73-83. [DOI: 10.1517/14656566.2014.860445] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
21
|
Abstract
INTRODUCTION Allergic rhinitis (AR) can be challenging to treat. For many patients, current therapies (including multiple therapies) provide insufficient symptom relief. There is, therefore, a clear unmet medical need for a new and more effective AR treatment option. MP29-02 ( Dymista ) is a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system. AREAS COVERED The goal of this article is to review all MP29-02 clinical data currently published with a view to establish its potential to fill the current unmet medical need in AR. Relevant articles and abstracts were reviewed from PUBMED and conference proceedings. EXPERT OPINION MP29-02 represents a breakthrough in AR management for the following reasons: i) MP29-02 has been extensively studied in comparison to first-line therapies in both seasonal AR (SAR) patients and in those with chronic rhinitis (i.e., perennial allergic rhinitis [PAR] and nonallergic (vasomotor) rhinitis) in one of the largest direct head-to-head clinical trial programmes in AR, to date. ii) With MP29-02, the efficacy of an intranasal corticosteroid (INS), the first-line choice for AR has been exceeded for the first time without safety repercussions. AR patients treated with MP29-02 experience significantly greater relief from their overall nasal and ocular symptoms compared to two first-line AR therapies, irrespective of season, symptom type, or disease severity. More patients treated with MP29-02 achieve a substantial reduction (i.e., 50% reduction) in their symptoms and also complete symptom relief and achieve these clinically relevant responses days faster than an INS or antihistamine. iii) Formulation of a topical medication is critical, and MP29-02's novel formulation and/or its device contribute to its clinical efficacy.
Collapse
Affiliation(s)
- Jonathan A Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine , 3255 Eden Avenue ML#563, Suite 350, Cincinnati, OH 45267-0563 , USA +1 513 558 5533 ; +1 513 558 3799 ;
| |
Collapse
|
22
|
Simultaneous determination of montelukast as sparing therapy with some inhaled corticosteroids in plasma of asthmatic patients. J Pharm Biomed Anal 2012; 74:250-6. [PMID: 23245258 DOI: 10.1016/j.jpba.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/02/2012] [Accepted: 11/03/2012] [Indexed: 11/20/2022]
Abstract
Montelukast (MKST) is a leukotriene receptor antagonist that has been concomitantly used with inhaled corticosteroids (ICS) for its steroid-sparing effect in the long-term management of asthma. However, the simultaneous determination of MKST, when used as ICS tapering therapy, with ICS in human plasma has not yet been reported. A fast and efficient reversed phase monolith HPLC method was developed for simultaneous determination of MKST with some ICS in plasma of asthmatic patients. The separation was achieved on monolith reversed phase column by isocratic mode at a flow rate of 1.0 ml min(-1) using a mobile phase consisted of a mixture of acetonitrile and 10mM phosphate buffer adjusted to pH 3.5 (40:60, v/v) and detected at 240 nm. Betamethasone dipropionate (BDP) was used as the internal standard. All the studied ICS and MKST were efficiently separated within less than 6 min. The obtained linearity range for the developed HPLC method was 0.03-10 μg ml(-1) with correlation coefficients>0.9995 and the detection limits were 0.009-0.016 μg ml(-1) in plasma for all the studied drugs. The method was validated in agreement with the requirements of US-FDA guideline and was recommended for the target applications. The method is valuable for investigations concerned with the effective tapering of ICS therapy with MKST in patients with chronic asthma in clinical practice without loss of asthma control.
Collapse
|