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Kumar A, Jain MK, Barge VB, Kumar RS, Gupta N, Yadav H, Pal A, Redkar VE, Mondal A, Rathore RK, Daultani P, Jaiswal A, Mehta RT. Efficacy and safety of Once-Daily Vilanterol/Fluticasone furoate MDI in persistent asthma: Phase 3 OD-INHALE Study. J Asthma 2024:1-9. [PMID: 38488853 DOI: 10.1080/02770903.2024.2330485] [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: 12/30/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Once-daily inhalers have been shown to improve adherence leading to lesser discontinuation compared to twice- or thrice-daily inhalers in management of asthma. Combination of Vilanterol and Fluticasone Furoate (VI/FF) is approved for management of asthma and COPD and is available as a dry powder inhaler. Pressurized-Metered Dose Inhalers (pMDIs) offer ease-of-use and therapy alternatives for patients with low inspiratory flow. This study assessed the efficacy and safety of a new once-daily pMDI containing VI/FF in individuals diagnosed with persistent asthma. METHODS This phase 3, double-blind, randomized controlled study assessed the non-inferiority of VI/FF (12.5 mcg/50 mcg & 12.5 mcg/100 mcg; 2 puffs once-daily) over Formoterol Fumarate and Fluticasone Propionate (FOR/FP, 6 mcg/125 mcg & 6 mcg/250 mcg; 2 puffs twice-daily) in patients with persistent asthma. Primary outcome was change from baseline in trough FEV1 at the end of study (12 weeks). Adverse events and number of exacerbations were used to evaluate safety. RESULTS A total of 330 patients were randomized into VI/FF (165) and FOR/FP (165). Trough FEV1 significantly improved in both the groups at week 12, with a mean difference (VI/FF minus FOR/FP) being 54.75 mL (95% CI, 8.42-101.08 mL, p = 0.02). The low dose VI/FF had similar efficacy to that of low dose FOR/FP and high dose VI/FF had similar efficacy to high dose FOR/FP. No serious adverse events were reported during the study. CONCLUSION Once daily VI/FF pMDI was non-inferior to twice daily FOR/FP pMDI in patients with persistent asthma.
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Affiliation(s)
- Avdhesh Kumar
- Department of Pulmonology, GSVM Medical College, Kanpur, India
| | | | - Vijaykumar Bhagwan Barge
- Department of Medicine, Rajarshee Chhatrapati Shahu Maharaj Govt. Medical College and Chhatrapati Pramila Raje General Hospital, Kolhapur, India
| | - Raghumanda Sunil Kumar
- Department of Pulmonology, Government Medical College & Government General Hospital (Old RIMSGGH), Srikakulam, India
| | - Neeraj Gupta
- Department of Pulmonary Medicine, Jawahar Lal Nehru (J.L.N) Medical College Ajmer, India
| | - Harendra Yadav
- Department of Pulmonology, Vidhya Hospitals & Trauma Centre, Lucknow, India
| | - Amitava Pal
- Department of Chest Medicine, College of Medicine & Sagore Dutta Hospital, Kolkata, India
| | | | - Asish Mondal
- Department of Medicine, Medical College and Hospital, Kolkata, India
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Baker JG, Shaw DE. Asthma and COPD: A Focus on β-Agonists - Past, Present and Future. Handb Exp Pharmacol 2023. [PMID: 37709918 DOI: 10.1007/164_2023_679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Asthma has been recognised as a respiratory disorder for millennia and the focus of targeted drug development for the last 120 years. Asthma is one of the most common chronic non-communicable diseases worldwide. Chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality worldwide, is caused by exposure to tobacco smoke and other noxious particles and exerts a substantial economic and social burden. This chapter reviews the development of the treatments of asthma and COPD particularly focussing on the β-agonists, from the isolation of adrenaline, through the development of generations of short- and long-acting β-agonists. It reviews asthma death epidemics, considers the intrinsic efficacy of clinical compounds, and charts the improvement in selectivity and duration of action that has led to our current medications. Important β2-agonist compounds no longer used are considered, including some with additional properties, and how the different pharmacological properties of current β2-agonists underpin their different places in treatment guidelines. Finally, it concludes with a look forward to future developments that could improve the β-agonists still further, including extending their availability to areas of the world with less readily accessible healthcare.
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Affiliation(s)
- Jillian G Baker
- Department of Respiratory Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Cell Signalling, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Dominick E Shaw
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Daley-Yates P, Singh D, Igea JM, Macchia L, Verma M, Berend N, Plank M. Assessing the Effects of Changing Patterns of Inhaled Corticosteroid Dosing and Adherence with Fluticasone Furoate and Budesonide on Asthma Management. Adv Ther 2023; 40:4042-4059. [PMID: 37438554 PMCID: PMC10427546 DOI: 10.1007/s12325-023-02585-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/13/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Pharmacological asthma management focuses on the use of inhaled corticosteroid (ICS)-containing therapies, which reduce airway inflammation and provide bronchoprotection, improving symptom control and reducing exacerbation risk. ICS underuse due to poor adherence is common, leading to poor clinical outcomes including increased risk of mortality. This article reviews efficacy versus systemic activity profiles for various adherence patterns and dosing regimens of fluticasone furoate (FF)-containing and budesonide (BUD)-containing asthma therapies in clinical trials and real-world studies. METHODS We performed a structured literature review (1 January 2000-3 March 2022) and mathematical modelling analysis of FF-containing and BUD-containing regular daily dosing in patients with mild-to-severe asthma, as-needed BUD/formoterol (FOR) in mild asthma, and BUD/FOR maintenance and reliever therapy (MART) dosing in moderate-to-severe asthma, to assess efficacy (bronchoprotection) and systemic activity (cortisol suppression) profiles of dosing patterns of ICS use in multiple adherence scenarios. RESULTS A total of 22 manuscripts were included in full-text review and 18 in the model simulations. Focusing on FF-containing or BUD-containing treatments at comparable adherence rates, regular daily FF or FF/vilanterol (VI) dosing provided more prolonged bronchoprotection and fewer systemic effects than daily BUD, daily BUD/FOR, or BUD/FOR MART dosing, especially in low adherence scenarios. In model simulations and the real-world setting, FF/VI generally provided longer bronchoprotection, lower systemic activity, and greater clinical benefits over BUD/FOR as well as consistently higher adherence. CONCLUSION In this literature review and modelling analysis, FF/VI was found to show clinical advantages on asthma control over BUD/FOR. These findings have implications for helping clinicians select the most suitable inhaled therapy for their patients with asthma.
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Affiliation(s)
| | - Dave Singh
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Norbert Berend
- Woolcock Institute for Medical Research, Glebe, NSW, Australia
| | - Maximilian Plank
- GSK, Prinzregentenpl. 9, 81675, Munich, Germany.
- University of Newcastle, Newcastle, Australia.
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Gon Y, Ishii T, Lawrence D, Nikolaev I, Wang D, Sumi K, Nakamura Y. Once-daily, single-inhaler indacaterol/mometasone versus twice-daily salmeterol/fluticasone in Asian patients with inadequately controlled asthma: Post hoc pooled analysis from PALLADIUM and IRIDIUM studies. J Asthma 2021; 59:1627-1637. [PMID: 34346266 DOI: 10.1080/02770903.2021.1962342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: PALLADIUM and IRIDIUM studies demonstrated efficacy and safety of indacaterol/mometasone (IND/MF) versus salmeterol/fluticasone (SAL/FLU). This post hoc analysis of pooled data from PALLADIUM and IRIDIUM studies evaluated efficacy and safety of IND/MF versus SAL/FLU in Asian patients with inadequately controlled asthma.Methods: Both studies were Phase III, 52-week, randomized, double-blind, active-controlled that included patients with predicted pre-bronchodilator FEV1 (PALLADIUM, ≥50%-<85%; IRIDIUM, <80%), ACQ-7 score ≥1.5. Patients treated with IND/MF high- (150/320μg) or medium-dose (150/160μg) or SAL/FLU high-dose (50/500μg) were included. Lung function, asthma control, and asthma exacerbations were evaluated.Results: In total, 323 patients (IND/MF high-dose, n = 107; IND/MF medium-dose, n = 106, SAL/FLU high-dose, n = 110) were included. IND/MF high-dose showed improvement in trough FEV1 versus SAL/FLU high-dose at Weeks 26 (Δ, 42 mL; 95% CI, -35 to 120 mL), and 52 (Δ, 41 mL; 95% CI, -37 to 120 mL). IND/MF high-dose exhibited numerically greater improvement in ACQ-7 score versus SAL/FLU high-dose at Weeks 26 (Δ, -0.215; 95% CI, -0.385 to -0.044) and 52 (Δ, -0.176; 95% CI, -0.348 to -0.005). Improvements in trough FEV1 and ACQ-7 score were comparable between IND/MF medium-dose and SAL/FLU high-dose. IND/MF high- and medium-dose showed reductions in moderate or severe (45%; 30%), severe (39%; 41%), and all (9%; 25%) exacerbations, respectively, versus SAL/FLU high-dose over 52 weeks. All treatments were well tolerated.Conclusions: Once-daily, single-inhaler IND/MF high-dose improved lung function with better asthma control, reduced asthma exacerbations with comparable safety versus twice-daily SAL/FLU high-dose. IND/MF medium-dose showed comparable outcomes to SAL/FLU high-dose at a reduced steroid dose.
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Affiliation(s)
- Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | - Yoichi Nakamura
- Department of Allergology, Medical Center for Allergy and Immune Diseases, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
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Yong YV, Mahamad Dom SH, Ahmad Sa'ad N, Lajis R, Md Yusof FA, Abdul Rahaman JA. Development and Practical Application of a Multiple-Criteria Decision Analysis Framework on Respiratory Inhalers: Is It Always Useful in the MOH Malaysia Medicines Formulary Listing Context? MDM Policy Pract 2021; 6:2381468321994063. [PMID: 33855190 PMCID: PMC8013673 DOI: 10.1177/2381468321994063] [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: 02/20/2020] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives. The current health technology assessment used to evaluate respiratory inhalers is associated with limitations that have necessitated the development of an explicit formulary decision-making framework to ensure balance between the accessibility, value, and affordability of medicines. This study aimed to develop a multiple-criteria decision analysis (MCDA) framework, apply the framework to potential and currently listed respiratory inhalers in the Ministry of Health Medicines Formulary (MOHMF), and analyze the impacts of applying the outputs, from the perspective of listing and delisting medicines in the formulary. Methods. The overall methodology of the framework development adhered to the recommendations of the ISPOR MCDA Emerging Good Practices Task Force. The MCDA framework was developed using Microsoft Excel 2010 and involved all relevant stakeholders. The framework was then applied to 27 medicines, based on data gathered from the highest levels of available published evidence, pharmaceutical companies, and professional opinions. The performance scores were analyzed using the additive model. The end values were then deliberated by an expert committee. Results. A total of eight main criteria and seven subcriteria were determined by the stakeholders. The economic criterion was weighted at 30%. Among the noneconomic criteria, "patient suitability" was weighted the highest. Based on the MCDA outputs, the expert committee recommended one potential medicine (out of three; 33%) be added to the MOHMF and one existing medicine (out of 24; 4%) be removed/delisted from the MOHMF. The other existing medicines remained unchanged. Conclusions. Although this framework was useful for deciding to add new medicines to the formulary, it appears to be less functional and impactful for the removal/delisting existing medicines from the MOHMF. The generalizability of this conclusion to other formulations remains to be confirmed.
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Affiliation(s)
- Yee Vern Yong
- Pharmacy Practice & Development Division, Ministry of Health Malaysia
| | | | | | - Rosliza Lajis
- National Pharmaceutical Regulatory Agency, Ministry of Health Malaysia
| | | | - Jamalul Azizi Abdul Rahaman
- Former Head of Therapeutic Drug Working Committee (TDWC) Respiratory (2014-2020), Serdang Hospital, Ministry of Health Malaysia
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Bernstein D, Andersen L, Forth R, Jacques L, Yates L. Once-daily fluticasone furoate/vilanterol versus twice-daily fluticasone propionate/salmeterol in patients with asthma well controlled on ICS/LABA. J Asthma 2018; 55:984-993. [PMID: 28961020 DOI: 10.1080/02770903.2017.1386214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aimed to demonstrate non-inferiority of once-daily fluticasone furoate/vilanterol 100/25 µg (FF/VI) to twice-daily fluticasone propionate/salmeterol 250/50 µg (FP/SAL) in adults/adolescents with asthma well controlled on inhaled corticosteroid/long-acting β2 agonist (ICS/LABA). METHODS This was a randomized, double-blind, double-dummy, parallel-group, 24-week study (NCT02301975/GSK study 201378). Patients whose asthma met study-defined criteria for control were randomized 1:1:1 to receive FF/VI, FP/SAL or twice-daily FP 250 µg for 24 weeks. Primary endpoint was change from baseline in evening trough forced expiratory volume in 1 second (FEV1). Secondary endpoints included rescue-/symptom-free 24-hour periods. Safety was also assessed. RESULTS The intent-to-treat (ITT) population included 1504 randomized and treated patients (504 FF/VI; 501 FP/SAL; 499 FP); mean age 43.5 years, 64% female. FF/VI demonstrated non-inferiority (using a margin of -100 mL) to FP/SAL for evening trough FEV1 at Week 24 (ITT: 19 mL [95% confidence interval (CI) -11 to 49]; per protocol population [N = 1336]: 6 mL [95% CI -27 to 40]). Improvement in evening trough FEV1 at Week 24 for both FF/VI (123 mL; p < 0.001) and FP/SAL (104 mL; p < 0.001) was greater than FP. FF/VI increased rescue-/symptom-free 24-hour periods by 1.2%/1.2% compared with FP/SAL. All treatments were well tolerated. On-treatment adverse event (AE) rates were 43% to 45% across arms; there were no drug-related serious AEs. CONCLUSIONS FF/VI was non-inferior to FP/SAL for evening trough FEV1 at 24 weeks. These data suggest that patients well controlled on FP/SAL could step across to FF/VI without loss of control.
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Affiliation(s)
- David Bernstein
- a University of Cincinnati College of Medicine and Bernstein Clinical Research Center , Cincinnati , OH , USA
| | | | - Richard Forth
- b GlaxoSmithKline , Research Triangle Park , NC , USA
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Song JU, Park HK, Lee J. Impact of dosage timing of once-daily inhaled corticosteroids in asthma: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2018; 120:512-519. [PMID: 29573961 DOI: 10.1016/j.anai.2017.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/14/2017] [Accepted: 12/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Once-daily inhaled corticosteroids (ICSs) are widely used as first-line therapy in patients with asthma. OBJECTIVE To compare the efficacy of ICSs administered once daily in the morning or evening as determined by lung function. METHODS Medline, Embase, and the Cochrane Central Register were searched for relevant clinical trials. The primary outcome was lung function assessed as trough forced expiratory volume in 1 second and peak expiratory flow at end point. RESULTS Eight randomized clinical trials involving 1,234 patients were analyzed. The total number of patients treated with once-daily ICS in the morning and evening was 628 and 606, respectively. Pooled estimates showed that ICS administered once daily in the evening resulted in mild improvements in trough forced expiratory volume in 1 second (mean difference 0.05 L; 95% confidence interval 0.01-0.09; P = .026; I2 = 22.5%) and morning peak expiratory flow (mean difference 13.92 L/min; 95% confidence interval 5.77-22.06; P = .001; I2 = 13%) at end point compared with morning dosing. The change in use of rescue medicine and the incidence of adverse events with once-daily ICS were not significantly different between the 2 dosing times. CONCLUSION Compared with morning dosing, ICSs administered once daily in the evening seemed to provide some benefits in lung function for patients with asthma. However, because of methodologic limitations, further large-scale randomized clinical trials for dosing time of once-daily ICSs are needed.
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Affiliation(s)
- Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang-si, Republic of Korea
| | - Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju-si, Republic of Korea.
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