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Pourmehran O, Zarei K, Pourchez J, Vreugde S, Psaltis A, Wormald PJ. Advancements in acoustic drug delivery for paranasal sinuses: A comprehensive review. Int J Pharm 2023; 644:123277. [PMID: 37516215 DOI: 10.1016/j.ijpharm.2023.123277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Chronic rhinosinusitis (CRS) impacts patients' quality of life and healthcare costs. Traditional methods of drug delivery, such as nasal sprays and irrigation, have limited effectiveness. Acoustic Drug Delivery (ADD) using a nebulizer offers targeted delivery of drug to the sinuses, which may improve the treatment of CRS. This review examines the influence of aerosol particle characteristics, aero-acoustic parameters, inlet flow conditions, and acoustic waves on sinus drug delivery. Key findings reveal that smaller particles improve the ADD efficiency, whereas larger sizes or increased density impair it. The oscillation amplitude of the air plug in the ostium is crucial for the ADD efficiency. Introducing acoustic waves at the NC-sinus system's resonance frequency improves aerosol deposition within sinuses. Future research should address advanced models, optimizing particle characteristics, investigating novel acoustic waveforms, incorporating patient-specific anatomy, and evaluating long-term safety and efficacy. Tackling these challenges, ADD could offer more effective and targeted treatments for sinus-related conditions such as CRS.
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Affiliation(s)
- Oveis Pourmehran
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
| | - Kavan Zarei
- Faculty of Mechanical Engineering, Tarbiat Modares University, Tehran, Iran
| | - Jeremie Pourchez
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, Sainbiose U1059, Centre CIS, F-42023 Saint-Etienne, France
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Alkis Psaltis
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide Medical School, The University of Adelaide, Adelaide 5011, Australia; Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville, South Australia, Australia.
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2
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Pourmehran O, Cazzolato B, Tian Z, Arjomandi M. The effect of inlet flow profile and nozzle diameter on drug delivery to the maxillary sinus. Biomech Model Mechanobiol 2022; 21:849-870. [PMID: 35137283 PMCID: PMC9132880 DOI: 10.1007/s10237-022-01563-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022]
Abstract
In this paper, the effect of the turbulence and swirling of the inlet flow and the diameter of the nozzle on the flow characteristics and the particles' transport/deposition patterns in a realistic combination of the nasal cavity (NC) and the maxillary sinus (MS) were examined. A computational fluid dynamics (CFD) model was developed in ANSYS® Fluent using a hybrid Reynolds averaged Navier–Stokes–large-eddy simulation algorithm. For the validation of the CFD model, the pressure distribution in the NC was compared with the experimental data available in the literature. An Eulerian–Lagrangian approach was employed for the prediction of the particle trajectories using a discrete phase model. Different inlet flow conditions were investigated, with turbulence intensities of 0.15 and 0.3, and swirl numbers of 0.6 and 0.9 applied to the inlet flow at a flow rate of 7 L/min. Monodispersed particles with a diameter of 5 µm were released into the nostril for various nozzle diameters. The results demonstrate that the nasal valve plays a key role in nasal resistance, which damps the turbulence and swirl intensities of the inlet flow. Moreover, it was found that the effect of turbulence at the inlet of the NC on drug delivery to the MS is negligible. It was also demonstrated that increasing the flow swirl at the inlet and decreasing the nozzle diameter improves the total particle deposition more than threefold due to the generation of the centrifugal force, which acts on the particles in the nostril and vestibule. The results also suggest that the drug delivery efficiency to the MS can be increased by using a swirling flow with a moderate swirl number of 0.6. It was found that decreasing the nozzle diameter can increase drug delivery to the proximity of the ostium in the middle meatus by more than 45%, which subsequently increases the drug delivery to the MS. The results can help engineers design a nebulizer to improve the efficiency of drug delivery to the maxillary sinuses.
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Affiliation(s)
- Oveis Pourmehran
- School of Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.
| | - Benjamin Cazzolato
- School of Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Zhao Tian
- School of Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Maziar Arjomandi
- School of Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
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Pourmehran O, Arjomandi M, Cazzolato B, Tian Z, Vreugde S, Javadiyan S, Psaltis AJ, Wormald PJ. Acoustic drug delivery to the maxillary sinus. Int J Pharm 2021; 606:120927. [PMID: 34303821 DOI: 10.1016/j.ijpharm.2021.120927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Abstract
Acoustic drug delivery (ADD) is an innovative method for drug delivery to the nose and paranasal sinuses and can be used to treat chronic rhinosinusitis (CRS). The underlying mechanism of ADD is based on the oscillatory exchange of air between the nasal cavity (NC) and the maxillary sinus (MS) through the ostium, which assists with the transfer of the drug particles from the NC to the sinuses. This study aims to examine the efficacy of ADD for drug delivery to the MS using an acoustic wave applied to nebulised aerosols entering the nostril. Here, the effect of acoustic frequency, amplitude, and nebulisation flowrate on the efficiency of ADD to the MS is investigated experimentally. A computational fluid dynamics model was also developed to understand the deposition and transport patterns of the aerosols. The results showed that superimposing an acoustic frequency of 328 Hz, which is the resonance frequency of the selected 3D printed model of the NC-MS combination, on the nebulised aerosols could improve the efficiency of the drug delivery to the MS by 75-fold compared with non-acoustic drug delivery case (p < 0.0001). The experimental data also shows that an increase in the amplitude of excitation, increases the concentration of aerosol deposition in the MS significantly; however, it reaches to a plateau at a sound pressure level of 120 dB re 20 µPa.
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Affiliation(s)
- Oveis Pourmehran
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia.
| | - Maziar Arjomandi
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Benjamin Cazzolato
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Zhao Tian
- School of Mechanical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Sarah Vreugde
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Shari Javadiyan
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Alkis J Psaltis
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
| | - Peter-John Wormald
- Department of Surgery - Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, SA, Australia
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4
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Intranasal Administration for Pain: Oxytocin and Other Polypeptides. Pharmaceutics 2021; 13:pharmaceutics13071088. [PMID: 34371778 PMCID: PMC8309171 DOI: 10.3390/pharmaceutics13071088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Pain, particularly chronic pain, remains one of the most debilitating and difficult-to-treat conditions in medicine. Chronic pain is difficult to treat, in part because it is associated with plastic changes in the peripheral and central nervous systems. Polypeptides are linear organic polymers that are highly selective molecules for neurotransmitter and other nervous system receptors sites, including those associated with pain and analgesia, and so have tremendous potential in pain therapeutics. However, delivery of polypeptides to the nervous system is largely limited due to rapid degradation within the peripheral circulation as well as the blood–brain barrier. One strategy that has been shown to be successful in nervous system deposition of polypeptides is intranasal (IN) delivery. In this narrative review, we discuss the delivery of polypeptides to the peripheral and central nervous systems following IN administration. We briefly discuss the mechanism of delivery via the nasal–cerebral pathway. We review recent studies that demonstrate that polypeptides such as oxytocin, delivered IN, not only reach key pain-modulating regions in the nervous system but, in doing so, evoke significant analgesic effects. IN administration of polypeptides has tremendous potential to provide a non-invasive, rapid and effective method of delivery to the nervous system for chronic pain treatment and management.
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Waniewska-Leczycka M, Cieslik T, Kowalik K, Sierdzinski J, Zagor MP. Comparison of Intranasal Steroid Application Using Nasal Saline Irrigation and a Mucosal Atomization Device to Treat Chronic Rhinosinusitis. J Aerosol Med Pulm Drug Deliv 2021; 34:311-321. [PMID: 33848434 DOI: 10.1089/jamp.2020.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Chronic rhinosinusitis (CRS) is a disease that can significantly reduce patients' quality of life (QoL). Intranasal steroid therapy is the most commonly used treatment for CRS. There are many evaluation tools dedicated to assessing CRS patients' QoL, but none of them evaluates QoL during local steroid therapy. Mucosal atomization devices (MADs) and nasal saline irrigation (NSI) are effective and safe methods of applying intranasal steroids for CRS patients. Materials and Methods: The sample population for this prospective study comprised 43 CRS patients. Following endoscopic sinus surgery, all participants received intranasal steroids administered via an MAD, followed by NSI for 1.5 months. Each participant completed the SNOT-22 (22-item Sino-Nasal Outcomes Test) score and a new questionnaire, the Complementary Topical Nasal Drug Delivery Questionnaire (the Complementary Questionnaire), at the end of 3 months of intranasal steroid therapy. Results: The patients' responses in both the SNOT-22 score and the Complementary Questionnaire revealed significant differences in their adverse experiences. The patients who received intranasal steroid treatment using NSI experienced more frequently delayed nasal drainage, higher frequency of ear symptoms, and facial pain/pressure, while those whose therapy was administered using an MAD reported complaints such as nasal irritation, nasal dryness, and postnasal drip with unpleasant taste/smell. Conclusion: We used the Complementary Questionnaire as an effective tool for assessment of the QoL of CRS patients. The SNOT-22 score and the Complementary Questionnaire make it possible to select an intranasal applicator tailored to a CRS patient's specific complaints.
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Affiliation(s)
- Martyna Waniewska-Leczycka
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Cieslik
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kowalik
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Sierdzinski
- Medical Informatics and Telemedicine Department, Medical University of Warsaw, Warsaw, Poland
| | - Mariola Popko Zagor
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland
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6
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Xu J, Tao J, Wang J. Design and Application in Delivery System of Intranasal Antidepressants. Front Bioeng Biotechnol 2020; 8:626882. [PMID: 33409272 PMCID: PMC7779764 DOI: 10.3389/fbioe.2020.626882] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
One of the major reasons why depressed patients fail their treatment course is the existence of the blood-brain barrier (BBB), which prevents drugs from being delivered to the central nervous system (CNS). In recent years, nasal drug delivery has achieved better systemic bioavailability and activity in low doses in antidepressant treatment. In this review, we focused on the latest strategies for delivery carriers (or formation) of intranasal antidepressants. We began this review with an overview of the nasal drug delivery systems, including nasal drug delivery route, absorption mechanism, advantages, and limitations in the nasal drug delivery route. Next, we introduced the development of nasal drug delivery devices, such as powder devices, liquid-based devices, and so on. Finally, intranasal delivery carriers of antidepressants in clinical studies, including nanogels, nanostructured lipid, liposomes nanoparticles, nanoemulsions/microemulsion, were summarized. Moreover, challenges and future perspectives on recent progress of intranasal delivery carriers in antidepressant treatments were discussed.
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Affiliation(s)
- Jingying Xu
- School of Marxism, Yanshan University, Qinhuangdao, China
- Mental Health Service Center, Yanshan University, Qinhuangdao, China
| | - Jiangang Tao
- School of Marxism, Yanshan University, Qinhuangdao, China
- Mental Health Service Center, Yanshan University, Qinhuangdao, China
| | - Jidong Wang
- Applied Chemistry Key Laboratory of Hebei Province, Hebei Key Laboratory of Heavy Metal Deep-Remediation in Water and Resource Reuse, Yanshan University, Qinhuangdao, China
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7
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Kashyap K, Shukla R. Drug Delivery and Targeting to the Brain Through Nasal Route: Mechanisms, Applications and Challenges. Curr Drug Deliv 2020; 16:887-901. [PMID: 31660815 DOI: 10.2174/1567201816666191029122740] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/05/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
Blood-brain barrier (BBB) provides restrictions for the transportation of various therapeutic agents to the brain. Efforts to directly target the brain by olfactory as well as trigeminal nerve pathway, bypassing BBB, have grown significantly in recent times. The intranasal route of transportation of the drug encompasses ability for the delivery of drug directly to the brain, improves site-specificity in the brain and avoids systemic side effects. In the current era, novel drug delivery systems are useful tools for targeting the brain without providing any harmful effects in nasal mucosa as well as the central nervous system. The complex structure of nasal cavity, mucociliary clearance, degradation by the enzymes present in nasal cavity and pathological conditions like rhinitis, common cold, etc. are the major disputes for nasal drug delivery. The use of nanotechnological approaches like solid lipid nanoparticles, polymeric nanoparticles, nanoemulsions, liposomes and polymeric micelles provides the ability to overcome these barriers. There are several emerging nasal drug delivery technologies produced by various pharmaceutical companies to conquer these hurdles. This review tries to address the recent developments in the area of direct drug delivery to the brain through the nasal route.
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Affiliation(s)
- Kanchan Kashyap
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Raebareli, India
| | - Rahul Shukla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Raebareli, India
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8
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Moraga-Espinoza D, Warnken Z, Moore A, Williams RO, Smyth HDC. A modified USP induction port to characterize nasal spray plume geometry and predict turbinate deposition under flow. Int J Pharm 2018; 548:305-313. [PMID: 29960037 DOI: 10.1016/j.ijpharm.2018.06.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Abstract
There is currently no in vitro technique for assessing plume geometry of nasal sprays under airflow conditions. However, a majority of FDA approved nasal products recommend that patients inhale during actuation. Therefore, a reproducible in vitro test that measures plume angles under physiologically relevant inhalation flow rates would be useful. The purpose of this study was to adapt the recently described Plume Induction Port Evaluator (PIPE) apparatus for nasal sprays under flow and correlate these with nasal cast deposition patterns. Mass Median Plume Angles (MMPAs) of four nasal spray formulations with increasing viscosities were determined using the PIPE apparatus in the absence and presence of airflow. MMPAs were then correlated to drug deposition within 3D printed nasal casts using airflow. We evaluated different inhalation instructions obtained from the package insert of nasal products. MMPAs significantly reduced (narrower angles) when using flow for the three formulations with the lowest viscosities. An increase in the turbinate deposition was observed in the nasal casts when just one of the nostrils was closed during inhalation, except by the highest viscosity formulation. The turbinate deposition numerically correlated with changes in the plume angles observed using PIPE.
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Affiliation(s)
- Daniel Moraga-Espinoza
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States; Escuela de Química y Farmacia, Facultad de Farmacia, Universidad de Valparaíso, Valparaíso, Chile; Centro de Investigación Farmacopea Chilena, Universidad de Valparaíso, Valparaíso, Chile
| | - Zachary Warnken
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
| | - Amanda Moore
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
| | - Robert O Williams
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States
| | - Hugh D C Smyth
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX, United States.
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9
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Dkhar LK, Bartley J, White D, Seyfoddin A. Intranasal drug delivery devices and interventions associated with post-operative endoscopic sinus surgery. Pharm Dev Technol 2017; 23:282-294. [DOI: 10.1080/10837450.2017.1389956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lari K. Dkhar
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Jim Bartley
- Bio Design Lab, School of Engineering, Auckland University of Technology, Auckland, New Zealand
- Counties Manukau District Health Board, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - David White
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Ali Seyfoddin
- Drug Delivery Research Group, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Bio Design Lab, School of Engineering, Auckland University of Technology, Auckland, New Zealand
- School of Interprofessional Health Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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10
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Khan AR, Liu M, Khan MW, Zhai G. Progress in brain targeting drug delivery system by nasal route. J Control Release 2017; 268:364-389. [PMID: 28887135 DOI: 10.1016/j.jconrel.2017.09.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 12/13/2022]
Abstract
The blood-brain barrier (BBB) restricts the transport of potential therapeutic moieties to the brain. Direct targeting the brain via olfactory and trigeminal neural pathways by passing the BBB has gained an important consideration for delivery of wide range of therapeutics to brain. Intranasal route of transportation directly delivers the drugs to brain without systemic absorption, thus avoiding the side effects and enhancing the efficacy of neurotherapeutics. Over the last several decades, different drug delivery systems (DDSs) have been studied for targeting the brain by the nasal route. Novel DDSs such as nanoparticles (NPs), liposomes and polymeric micelles have gained potential as useful tools for targeting the brain without toxicity in nasal mucosa and central nervous system (CNS). Complex geometry of the nasal cavity presented a big challenge to effective delivery of drugs beyond the nasal valve. Recently, pharmaceutical firms utilized latest and emerging nasal drug delivery technologies to overcome these barriers. This review aims to describe the latest development of brain targeted DDSs via nasal administration. CHEMICAL COMPOUNDS STUDIED IN THIS ARTICLE Carbopol 934p (PubChem CID: 6581) Carboxy methylcellulose (PubChem CID: 24748) Penetratin (PubChem CID: 101111470) Poly lactic-co-glycolic acid (PubChem CID: 23111554) Tween 80 (PubChem CID: 5284448).
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Affiliation(s)
- Abdur Rauf Khan
- Department of Pharmaceutics, College of Pharmacy, Shandong University, 44 Wenhua Xilu, Jinan 250012, China
| | - Mengrui Liu
- Department of Pharmaceutics, College of Pharmacy, Shandong University, 44 Wenhua Xilu, Jinan 250012, China
| | - Muhammad Wasim Khan
- Department of Pharmaceutics, College of Pharmacy, Shandong University, 44 Wenhua Xilu, Jinan 250012, China
| | - Guangxi Zhai
- Department of Pharmaceutics, College of Pharmacy, Shandong University, 44 Wenhua Xilu, Jinan 250012, China.
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11
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Young PM, Traini D, Ong HX, Granieri A, Zhu B, Scalia S, Song J, Spicer PT. Novel nano-cellulose excipient for generating non-Newtonian droplets for targeted nasal drug delivery. Drug Dev Ind Pharm 2017; 43:1729-1733. [DOI: 10.1080/03639045.2017.1339078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Paul M. Young
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, School of Medicine, University of Sydney, Glebe, New South Wales, Australia
| | - Daniela Traini
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, School of Medicine, University of Sydney, Glebe, New South Wales, Australia
| | - Hui Xin Ong
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, School of Medicine, University of Sydney, Glebe, New South Wales, Australia
| | - Angelo Granieri
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, School of Medicine, University of Sydney, Glebe, New South Wales, Australia
| | - Bing Zhu
- Respiratory Technology, Woolcock Institute of Medical Research and Discipline of Pharmacology, School of Medicine, University of Sydney, Glebe, New South Wales, Australia
| | - Santo Scalia
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Jie Song
- Complex Fluids Group, School of Chemical Engineering, UNSW Australia, Sydney, New South Wales, Australia
| | - Patrick T. Spicer
- Complex Fluids Group, School of Chemical Engineering, UNSW Australia, Sydney, New South Wales, Australia
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12
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Yanez A, Dimitroff A, Bremner P, Rhee CS, Luscombe G, Prillaman BA, Johnson N. A patient preference study that evaluated fluticasone furoate and mometasone furoate nasal sprays for allergic rhinitis. ALLERGY & RHINOLOGY 2016; 7:183-192. [PMID: 28683244 PMCID: PMC5244277 DOI: 10.2500/ar.2016.7.0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Corticosteroid nasal sprays are the mainstay of treatment for allergic rhinitis. These sprays have sensory attributes such as scent and/or odor, taste and aftertaste, and run down the throat and/or the nose, which, when unpleasant, can affect patient preference for, and compliance with, treatment. Objective: This study examined patient preference for fluticasone furoate nasal spray (FFNS) or mometasone furoate nasal spray (MFNS) based on their sensory attributes after administration in patients with allergic rhinitis. Methods: This was a multicenter, randomized, double-blind, cross-over study. Patient preferences were determined by using three questionnaires (Overall Preference, Immediate Attributes, and Delayed Attributes). Results: Overall, 56% of patients stated a preference for FFNS versus 32% for MFNS (p < 0.001); the remaining 12% stated no preference. More patients stated a preference for FFNS versus MFNS for the attributes of “less drip down the throat” (p < 0.001), “less run out of the nose” (p < 0.05), “more soothing” (p < 0.05), and “less irritating” (p < 0.001). More patients responded in favor of FFNS versus MFNS for the immediate attributes, “run down the throat” (p < 0.001), and “run out of the nose” (p < 0.001), and, in the delayed attributes, “run down the throat” (p < 0.001), “run out of the nose” (p < 0.01), “presence of aftertaste” (p < 0.01), and “no nasal irritation” (p < 0.001). Conclusion: Patients with allergic rhinitis preferred FFNS versus MFNS overall and based on a number of individual attributes, including “less drip down the throat,” “less run out of the nose,” and “less irritating.” Greater preference may improve patient adherence and thereby improve symptom management of the patient's allergic rhinitis.
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Affiliation(s)
- Anahi Yanez
- Department of Clinical Research, Allergy and Respiratory Disease, Buenos Aires, Argentina
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13
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Pozzoli M, Ong HX, Morgan L, Sukkar M, Traini D, Young PM, Sonvico F. Application of RPMI 2650 nasal cell model to a 3D printed apparatus for the testing of drug deposition and permeation of nasal products. Eur J Pharm Biopharm 2016; 107:223-33. [PMID: 27418393 DOI: 10.1016/j.ejpb.2016.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 01/24/2023]
Abstract
The aim of this study was to incorporate an optimized RPMI2650 nasal cell model into a 3D printed model of the nose to test deposition and permeation of drugs intended for use in the nose. The nasal cell model was optimized for barrier properties in terms of permeation marker and mucus production. RT-qPCR was used to determine the xenobiotic transporter gene expression of RPMI 2650 cells in comparison with primary nasal cells. After 14days in culture, the cells were shown to produce mucus, and to express TEER (define) values and sodium fluorescein permeability consistent with values reported for excised human nasal mucosa. In addition, good correlation was found between RPMI 2650 and primary nasal cell transporter expression values. The purpose-built 3D printed model of the nose takes the form of an expansion chamber with inserts for cells and an orifice for insertion of a spray drug delivery device. This model was validated against the FDA glass chamber with cascade impactors that is currently approved for studies of nasal products. No differences were found between the two apparatus. The apparatus including the nasal cell model was used to test a commercial nasal product containing budesonide (Rhinocort, AstraZeneca, Australia). Drug deposition and transport studies on RPMI 2650 were successfully performed. The new 3D printed apparatus that incorporates cells can be used as valid in vitro model to test nasal products in conditions that mimic the delivery from nasal devices in real life conditions.
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Affiliation(s)
- Michele Pozzoli
- Graduate School of Health - Pharmacy, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Hui Xin Ong
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Lucy Morgan
- Concord Repatriation General Hospital, Sydney Medical School-Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Maria Sukkar
- Graduate School of Health - Pharmacy, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Daniela Traini
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Paul M Young
- Respiratory Technology, The Woolcock Institute of Medical Research and Discipline of Pharmacology, Sydney Medical School, University of Sydney, 431 Glebe Point Road, Glebe, NSW 2037, Australia
| | - Fabio Sonvico
- Graduate School of Health - Pharmacy, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia; Department of Pharmacy, University of Parma, 27A, Parco area delle Scienze, Parma 43124, Italy.
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Yonezaki M, Akiyama K, Karaki M, Goto R, Inamoto R, Samukawa Y, Kobayashi R, Kobayashi E, Hoshikawa H. Preference evaluation and perceived sensory comparison of fluticasone furoate and mometasone furoate intranasal sprays in allergic rhinitis. Auris Nasus Larynx 2016; 43:292-7. [DOI: 10.1016/j.anl.2015.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/11/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
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Okubo K, Okamasa A, Honma G, Komatsubara M. Safety and efficacy of fluticasone furoate nasal spray in Japanese children 2 to <15 years of age with perennial allergic rhinitis: a multicentre, open-label trial. Allergol Int 2015; 64:60-5. [PMID: 25572559 DOI: 10.1016/j.alit.2014.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/22/2014] [Accepted: 07/03/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Fluticasone furoate nasal spray (FFNS) is a glucocorticoid developed for the treatment of allergic rhinitis (AR). This study aimed to assess the safety, efficacy, and systemic exposure of FFNS in Japanese children with perennial AR (PAR). METHODS In this multicentre, open-label, phase 3 study, 61 children aged 2 to <15 years were treated with FFNS 55 μg, once daily for 12 weeks. Nasal and ocular symptoms were scored by parents/guardians/patients and recorded in a patient's daily diary. In addition, rhinoscopy findings, including mucosal swelling, were scored by the investigators as an efficacy measure. As a safety measure, adverse events and clinical laboratory data were evaluated. RESULTS An adverse event was reported by 67% of patients during the treatment and follow-up period, all of which were mild in intensity. The most commonly reported adverse events were nasopharyngitis and acute sinusitis (acute rhinosinusitis). There were no serious adverse events. FFNS 55 μg improved nasal symptom scores and rhinoscopy findings compared with the baseline. Ocular symptom scores were also improved compared with the baseline in FFNS 55 μg in a sub-group of patients with any ocular symptoms at baseline. FFNS 55 μg was shown to be well tolerated over the 12-week treatment period. Majority of patients receiving FFNS 55 μg had unquantifiable plasma levels of fluticasone furoate (FF). CONCLUSIONS Twelve-week treatment with FFNS 55 μg, once daily, is well tolerated and effective with low systemic exposure in Japanese children aged 2 to <15 years with PAR.
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Affiliation(s)
- Kimihiro Okubo
- Department of Head & Neck and Sensory Organ Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Arisa Okamasa
- Development and Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Gosuke Honma
- Development and Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Masaki Komatsubara
- Development and Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
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Okubo K, Okamasa A, Honma G, Komatsubara M. Efficacy and safety of fluticasone furoate nasal spray in Japanese children with perennial allergic rhinitis: a multicentre, randomized, double-blind, placebo-controlled trial. Allergol Int 2014; 63:543-51. [PMID: 25056227 DOI: 10.2332/allergolint.14-oa-0688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/11/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fluticasone furoate nasal spray (FFNS) is a glucocorticoid developed for the treatment of allergic rhinitis (AR). This is the first randomized clinical trial to assess the efficacy and safety of FFNS in Japanese children with perennial AR (PAR). METHODS In this multicentre, randomized, double-blind, placebo-controlled, parallel-group, phase III study, 261 children aged 6 to <15 years were treated with FFNS 55μg, once daily or placebo for two weeks. Nasal and ocular symptoms were rated by parents/guardians/patients in the patient daily diary. The primary endpoint was the mean change from baseline in the three total nasal symptom score (3TNSS). In addition, rhinoscopic findings were rated by the investigators as an efficacy measure. As a safety measure, adverse events and clinical chemistry and hematology were evaluated. RESULTS Mean change from baseline over the entire treatment period in 3TNSS was greater in the FFNS 55μg group compared with placebo, and the difference was statistically significant (p < 0.001). Significant improvements in rhinoscopic findings of swelling of inferior turbinate mucosa and quantity of nasal discharge were also observed. The total ocular symptom score (TOSS) was reduced significantly in the FFNS 55μg group, compared with placebo, in the second week in a subgroup of patients with baseline TOSS > 0. The incidence of adverse events was similar between FFNS 55μg(18%) and placebo (19%). CONCLUSIONS Two-week treatment with FFNS 55μg, once daily is effective and tolerable in Japanese children aged 6 to <15 years with PAR.
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Affiliation(s)
- Kimihiro Okubo
- Department of Head & Neck and Sensory Organ Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Arisa Okamasa
- Development and Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Gosuke Honma
- Development and Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Masaki Komatsubara
- Development and Medical Affairs Division, GlaxoSmithKline K.K., Tokyo, Japan
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Shah SA, Dickens CJ, Ward DJ, Banaszek AA, George C, Horodnik W. Design of experiments to optimize an in vitro cast to predict human nasal drug deposition. J Aerosol Med Pulm Drug Deliv 2013; 27:21-9. [PMID: 23461532 DOI: 10.1089/jamp.2012.1011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies showed nasal spray in vitro tests cannot predict in vivo deposition, pharmacokinetics, or pharmacodynamics. This challenge makes it difficult to assess deposition achieved with new technologies delivering to the therapeutically beneficial posterior nasal cavity. In this study, we determined best parameters for using a regionally divided nasal cast to predict deposition. Our study used a model suspension and a design of experiments to produce repeatable deposition results that mimic nasal deposition patterns of nasal suspensions from the literature. METHODS The seven-section (the nozzle locator, nasal vestibule, front turbinate, rear turbinate, olfactory region, nasopharynx, and throat filter) nylon nasal cast was based on computed tomography images of healthy humans. It was coated with a glycerol/Brij-35 solution to mimic mucus. After assembling and orienting, airflow was applied and nasal spray containing a model suspension was sprayed. After disassembling the cast, drug depositing in each section was assayed by HPLC. The success criteria for optimal settings were based on nine in vivo studies in the literature. The design of experiments included exploratory and half factorial screening experiments to identify variables affecting deposition (angles, airflow, and airflow time), optimization experiments, and then repeatability and reproducibility experiments. RESULTS We found tilt angle and airflow time after actuation affected deposition the most. The optimized settings were flow rate of 16 L/min, postactuation flow time of 12 sec, a tilt angle of 23°, nozzle angles of 0°, and actuation speed of 5 cm/sec. Neither cast nor operator caused significant variation of results. CONCLUSION We determined cast parameters to produce results resembling suspension nasal sprays in the literature. The results were repeatable and unaffected by operator or cast. These nasal spray parameters could be used to assess deposition from new devices or formulations. For human deposition studies using radiolabeled formulations, this cast could show that radiolabel deposition represents drug deposition. Our methods could also be used to optimize settings for other casts.
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Affiliation(s)
- Samir A Shah
- 1 Respiratory Product Development, Merck Research Labs , Summit, NJ 07901
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Djupesland PG. Nasal drug delivery devices: characteristics and performance in a clinical perspective-a review. Drug Deliv Transl Res 2013; 3:42-62. [PMID: 23316447 PMCID: PMC3539067 DOI: 10.1007/s13346-012-0108-9] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nasal delivery is the logical choice for topical treatment of local diseases in the nose and paranasal sinuses such as allergic and non-allergic rhinitis and sinusitis. The nose is also considered an attractive route for needle-free vaccination and for systemic drug delivery, especially when rapid absorption and effect are desired. In addition, nasal delivery may help address issues related to poor bioavailability, slow absorption, drug degradation, and adverse events in the gastrointestinal tract and avoids the first-pass metabolism in the liver. However, when considering nasal delivery devices and mechanisms, it is important to keep in mind that the prime purpose of the nasal airway is to protect the delicate lungs from hazardous exposures, not to serve as a delivery route for drugs and vaccines. The narrow nasal valve and the complex convoluted nasal geometry with its dynamic cyclic physiological changes provide efficient filtration and conditioning of the inspired air, enhance olfaction, and optimize gas exchange and fluid retention during exhalation. However, the potential hurdles these functional features impose on efficient nasal drug delivery are often ignored. With this background, the advantages and limitations of existing and emerging nasal delivery devices and dispersion technologies are reviewed with focus on their clinical performance. The role and limitations of the in vitro testing in the FDA guidance for nasal spray pumps and pressurized aerosols (pressurized metered-dose inhalers) with local action are discussed. Moreover, the predictive value and clinical utility of nasal cast studies and computer simulations of nasal airflow and deposition with computer fluid dynamics software are briefly discussed. New and emerging delivery technologies and devices with emphasis on Bi-Directional™ delivery, a novel concept for nasal delivery that can be adapted to a variety of dispersion technologies, are described in more depth.
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Fokkens WJ, Rinia B, van Drunen CM, Hellings PW, Hens G, Jansen A, Blom H, Wu W, Clements DS, Lee LA, Philpot EE. No mucosal atrophy and reduced inflammatory cells: active-controlled trial with yearlong fluticasone furoate nasal spray. Am J Rhinol Allergy 2012; 26:36-44. [PMID: 22391079 DOI: 10.2500/ajra.2012.26.3675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Fluticasone furoate nasal spray (FFNS) and mometasone furoate nasal spray (MFNS) are well tolerated and more effective than placebo at relieving the symptoms of seasonal and perennial allergic rhinitis. Effects of FFNS on the nasal histology have not been previously reported. This study examines the effects of FFNS and MFNS, administered daily for 1 year, on the nasal mucosa in subjects with perennial allergic rhinitis. METHODS Subjects with perennial allergic rhinitis were randomized 1:1 to q.d., open-label treatment with FFNS, 110 μg, or MFNS, 200 μg, for 1 year. These groups and a healthy control group that did not receive study medication underwent nasal biopsies at baseline and 12 months. RESULTS The nasal biopsy population comprised 96 participants (37 using FFNS, 42 using MFNS, and 17 healthy controls). Epithelial thickness did not change appreciably from baseline to week 52 in any of the groups and mean change from baseline did not differ between FFNS and MFNS (least square mean difference, -0.001 mm, 95% confidence interval, -0.007, 0.006). Although not tested for significance, improvements over baseline were observed in epithelial histology in the FFNS group with more epithelium including intact columnar and ciliated epithelial cells. No appreciable change in the percentage of goblet cells was established. FFNS and MFNS were associated with decreases in epithelial and subepithelial nasal mucosal eosinophils and basophils from baseline to week 52. The percentage of subjects with no inflammatory cells at week 52 was 49 and 33% for eosinophils and 46 and 24% for basophils, for FFNS and MFNS, respectively. CONCLUSION Yearlong therapy with either FFNS or MFNS showed no changes in epithelial thickness or the percentage of goblet cells as well as a reduction in inflammatory cell infiltrate. FFNS was associated with improvements in epithelial histology. These data support the long-term safety of FFNS in subjects with perennial allergic rhinitis.
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Affiliation(s)
- Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
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Anolik R. Fluticasone furoate nasal spray: Profile of an enhanced-affinity corticosteroid in treatment of seasonal allergic rhinitis. J Asthma Allergy 2010; 3:87-99. [PMID: 21437043 PMCID: PMC3047912 DOI: 10.2147/jaa.s10839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 11/23/2022] Open
Abstract
Of the classes of pharmacotherapy for seasonal allergic rhinitis, intranasal corticosteroids are the preferred treatment and are recommended in practice guidelines as first-line pharmacotherapy for rhinitis with prominent nasal congestion. The enhanced-affinity intranasal corticosteroid fluticasone furoate nasal spray (GW685698X), is one of the newest additions to the armamentarium for allergic rhinitis. This review summarizes the preclinical and clinical data on fluticasone furoate nasal spray and discusses its place in pharmacotherapy for seasonal allergic rhinitis. Important attributes of fluticasone furoate in seasonal allergic rhinitis include low systemic bioavailability (<0.5%), onset of symptom relief as early as eight hours after initiation of treatment, 24-hour symptom relief with once-daily dosing, comprehensive coverage of both nasal and ocular symptoms, safety and tolerability with daily use, and availability in a side-actuated device that makes medication delivery simple and consistent. With these attributes, fluticasone furoate nasal spray has the potential to enhance patient satisfaction and compliance and reduce the need for polypharmacy in the management of seasonal allergic rhinitis.
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Affiliation(s)
- Robert Anolik
- Allergy and Asthma Specialists, PC, Blue Bell, Pennsylvania, USA
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Meltzer EO, Andrews C, Journeay GE, Lim J, Prillaman BA, Garris C, Philpot E. Comparison of patient preference for sensory attributes of fluticasone furoate or fluticasone propionate in adults with seasonal allergic rhinitis: a randomized, placebo-controlled, double-blind study. Ann Allergy Asthma Immunol 2010; 104:331-8. [PMID: 20408344 DOI: 10.1016/j.anai.2010.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intranasal corticosteroids are first-line treatment for moderate-to-severe seasonal allergic rhinitis (AR). OBJECTIVES To compare preferences for fluticasone furoate and fluticasone propionate nasal sprays after 1 week of treatment in patients with symptomatic seasonal AR. METHODS Patients with seasonal AR were enrolled (n = 360) and randomized 1:1 to active treatment (fluticasone furoate, 110 microg, or fluticasone propionate, 200 microg, followed by crossover treatment for 1 week each) or matched placebo sequence with a 1-week washout before crossover dosing. Fluticasone furoate and fluticasone propionate efficacy was measured by change from baseline during 1 week in daily reflective total nasal symptom score (rTNSS) that assessed severity of rhinorrhea, nasal congestion, nasal itching, and sneezing. Patient preference for fluticasone furoate or fluticasone propionate was assessed at the end of the study by questionnaire. RESULTS Three hundred sixty patients from 29 clinical sites in the Unites States were randomized and treated between August 1, 2007 and November 30, 2007. Most patients were white (73%) and female (59%), with a mean age of 38.3 years, and had had seasonal AR for at least 10 years (74%). Fluticasone furoate and fluticasone propionate each reduced the daily rTNSS compared with their respective placebos (least squares mean [SD] difference, -0.8 [0.24], P < .001, and -0.6 [0.24], P = .01, respectively). More patients (P < .001) preferred fluticasone furoate to fluticasone propionate based on attributes of scent or odor (58% vs 27%), aftertaste (60% vs 18%), leaking out of the nose and down the throat (59% vs 21%), and mist gentleness (57% vs 26%). No statistically significant differences were seen in preferences regarding ease of use, delivery method, or device comfort. CONCLUSION Both fluticasone furoate and fluticasone propionate significantly improved symptoms in adult patients with seasonal AR. Most patients preferred the sensory attributes of fluticasone furoate to those of fluticasone propionate after 1 week of treatment.
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Affiliation(s)
- Eli O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, California 92123, USA.
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Preferences of adult patients with allergic rhinitis for the sensory attributes of fluticasone furoate versus fluticasone propionate nasal sprays: a randomized, multicenter, double-blind, single-dose, crossover study. Clin Ther 2009; 30:271-9. [PMID: 18343265 DOI: 10.1016/j.clinthera.2008.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Product attributes influence patient preference for intranasal corticosteroid therapy in allergic rhinitis (AR). OBJECTIVE The aim of the study was to compare the product sensory attributes and patient preferences of fluticasone furoate (FF) and fluticasone propionate (FP) nasal sprays in patients with symptomatic perennial and/or seasonal AR. METHODS This randomized, multicenter, double-blind, single-dose, crossover study enrolled 127 patients with a diagnosis of AR as determined by respiratory symptoms and a positive skin test to perennial and/or seasonal allergens within 12 months prior to the study. Patients could not use FF or FP within 4 weeks prior to the start of the study. Patients were randomized 1:1 to receive FF (110 microg) followed by FP (200 microg) or FP followed by FF. A 10-minute washout period occurred before crossover dosing. Following each treatment, patient-rated sensory attributes were assessed immediately and 2 minutes after treatment on 2 questionnaires using a 7-point Likert scale (scored from 0-6) rating odor, taste, aftertaste, drip down the throat, urge to sneeze, soothing feeling, irritation, and nose runoff. At the end of the crossover dosing and after completion of the attributes questionnaires, preference for individual attributes of FF or FP nasal spray and overall patient preference were evaluated in a third questionnaire that asked "Based on these attributes, which product did you prefer overall?" Additionally, a follow-up phone call was conducted 24 hours after the study to assess any adverse events following study treatment. RESULTS Patients (mean age, 39.7 years; 80% white; 65% women) preferred FF nasal spray over FP nasal spray overall (60% vs 33%; P = 0.003) and based on the individual attributes of odor (64% vs 29%; P < 0.001), taste (47% vs 21%; P < 0.001), aftertaste (44% vs 22%; P = 0.002), drip down the throat (43% vs 27%; P = 0.037), and nose runoff (49% vs 19%; P < 0.001). Patient ratings favored FF versus FP (median differences, P < 0.001) with respect to odor, taste, dripping down the throat, and nose runoff, both immediately and 2 minutes after dosing, but there were no significant differences with respect to whether the medication felt soothing, caused nasal irritation, or made patients sneeze. Fifty-two percent (63/121) of patients replied that they were very likely to comply with FF treatment versus FP treatment (38% [45/120]; P = 0.02) if the medications were prescribed. Three patients (2%) reported adverse events (dizziness, headache, nasal congestion) during treatment with FF. CONCLUSION In this study of adult AR patients, the sensory attributes of FF were preferred over those of FP following single-dose administration.
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Jacobs R, Martin B, Hampel F, Toler W, Ellsworth A, Philpot E. Effectiveness of fluticasone furoate 110 microg once daily in the treatment of nasal and ocular symptoms of seasonal allergic rhinitis in adults and adolescents sensitized to mountain cedar pollen. Curr Med Res Opin 2009; 25:1393-401. [PMID: 19419338 DOI: 10.1185/03007990902890512] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fluticasone furoate (FF) is a novel enhanced-affinity corticosteroid for the treatment of allergic rhinitis, delivered by a unique side-actuated device. This study was designed to investigate the efficacy and safety of FF nasal spray (FFNS) 110 microg once daily compared with placebo in adults and adolescents (aged > or =12 years) with seasonal allergic rhinitis (SAR) symptoms caused by mountain cedar (Juniperus ashei) pollen. METHODS This was a randomized, double-blind, placebo-controlled, parallel-group, phase III study conducted over a 2-week period (between 10 December 2004 and 19 January 2005) at seven study sites, in Austin, Texas, USA, and San Antonio, Texas, two metropolitan cities in the central Texas Hill Country located approximately 80 miles apart. Adult and adolescent patients (aged > or =12 years) with SAR, who were sensitized to mountain cedar (Juniperus ashei) pollen, were randomized to receive either FFNS 110 microg (n = 152) or placebo (n = 150) once daily. Patients rated the severity of each nasal symptom (rhinorrhea, nasal congestion, nasal itching, and sneezing) and ocular symptom (redness, watery eyes, itching and burning) on a 4-point categorical scale (0 = none, 3 = severe) in a reflective and instantaneous manner. Patients also rated their overall evaluation of response to therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT00115622. RESULTS FFNS significantly improved the nasal symptoms of SAR compared with placebo. The least square (LS) mean difference in the reflective total nasal symptom score (TNSS) was -0.777 (p = 0.003). A significant reduction in morning pre-dose instantaneous TNSS was also observed compared with placebo (LS mean difference -0.902; p < 0.001). Patients receiving FFNS had significantly greater improvements from baseline in reflective total ocular symptom scores (TOSS) than those receiving placebo (LS mean difference -0.546; p = 0.008). Significant improvements in ocular symptoms with FFNS versus placebo were also observed for morning pre-dose instantaneous TOSS (LS mean difference -0.519; p = 0.009). FFNS had a favorable safety and tolerability profile: fewer adverse events occurred with FFNS (22%) than with placebo (29%), and no serious adverse events were observed. CONCLUSIONS FFNS 110 microg once daily demonstrated efficacy in relieving both the nasal and ocular symptoms of SAR in adult and adolescent patients.
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Affiliation(s)
- Robert Jacobs
- Biogenics Research Institute, San Antonio, TX 78229, USA.
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Tripathy I, Levy A, Ratner P, Clements D, Wu W, Philpot E. HPA axis safety of fluticasone furoate nasal spray once daily in children with perennial allergic rhinitis. Pediatr Allergy Immunol 2009; 20:287-94. [PMID: 19175889 DOI: 10.1111/j.1399-3038.2008.00775.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The effects of intranasal corticosteroids (INSs) on the hypothalamic-pituitary-adrenal (HPA) axis should be assessed for any to be marketed INS. The objective of this study was to assess the effects of fluticasone furoate nasal spray (FFNS) on cortisol production (as a measure of HPA axis function) following 6 wk of treatment with FFNS 110 microg once daily (QD) compared with placebo in pediatric patients with perennial allergic rhinitis (PAR). In this double-blind, parallel-group study, patients (n = 112) aged 2-11 yr with a 1-yr history of PAR (6 months for patients aged 2-3 yr) were randomized in a 1:1 ratio to either placebo or FFNS. Serum cortisol (SC) concentrations and urinary cortisol (UC) excretion were measured over a 24-h period at the randomization (baseline) and final treatment (week 6) visits for HPA axis evaluation in a domiciled environment (overnight in the clinic). Plasma samples were collected for FFNS at several time points over the 24 h after the final dose for pharmacokinetic analyses. FFNS was non-inferior to placebo with respect to change from baseline (expressed as a ratio) in 24-h SC weighted mean. The lower limit of the two-sided 95% confidence interval (CI) for the treatment ratio was greater than the pre-specified non-inferiority margin of 0.8 (treatment ratio = 0.97, 95% CI 0.88-1.07). UC excretion over 24 h at baseline and end of treatment was similar between treatment groups; no patients had 24-h excretion levels below normal range after 6 wk of treatment. Plasma concentrations of FFNS were generally non-quantifiable (<10 pg/ml). Results of the current study indicate that FFNS 110 microg QD has no significant effect on HPA axis function in 2- to 11-yr-old pediatric patients with PAR.
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Affiliation(s)
- Ita Tripathy
- Phelps County Regional Medical Center, 509 E 10th Street, Rolla, MO 65401, USA.
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Lack of effect on adult and adolescent hypothalamic-pituitary-adrenal axis function with use of fluticasone furoate nasal spray. Ann Allergy Asthma Immunol 2008; 100:490-6. [PMID: 18517083 DOI: 10.1016/s1081-1206(10)60476-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intranasal corticosteroids are recommended as first-line therapy for allergic rhinitis (AR), and because of their pharmacologic class, hypothalamic-pituitary-adrenal (HPA) axis function is evaluated. OBJECTIVE To evaluate whether cortisol production was suppressed (as a measure of HPA axis function) by 6 weeks of treatment with fluticasone furoate nasal spray, 110 microg once daily, in patients with perennial AR. METHODS A double-blind, randomized, placebo- and active-controlled (prednisone), parallel-group study. Outpatients aged 12 to 65 years with perennial AR for 2 years or more were from 1 center in the United States and 1 center in Canada. Pharmacodynamic and pharmacokinetic samples were collected during 24-hour domiciled visits (overnight in clinic). Measurements included change from baseline in 24-hour serum cortisol weighted mean and 24-hour urinary free cortisol excretion, total 24-hour urinary free cortisol excretion and 6-beta hydroxycortisol excretion, and plasma concentration of fluticasone furoate. RESULTS A total of 112 of 183 patients were randomized. Fluticasone furoate was noninferior to placebo with respect to the ratio from baseline in serum cortisol weighted mean (treatment ratio, 0.98; 95% confidence interval, 0.89 to 1.07). In contrast, use of prednisone, 10 mg once daily, significantly reduced the ratio from baseline compared with placebo. Change from baseline in 24-hour urinary cortisol excretion was similar in the fluticasone furoate and placebo groups. Plasma levels of fluticasone furoate were undetectable after 6 weeks of treatment. CONCLUSION Fluticasone furoate nasal spray, 110 microg once daily, was not associated with HPA axis suppression in patients 12 years and older with perennial AR.
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