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Salvi S, Kumar A, Agrawal S, Leuva A, Shukla VK, Deshpande SV, Balamurugan S, Singh A, Tikkiwal S, Gupta SK, Singh BP, Lopez M, Sawant S, Vaidya A, Gogtay J. Efficacy and safety of glycopyrronium/formoterol delivered via a dry powder inhaler in patients with moderate to severe chronic obstructive pulmonary disease: Results from a multi-centre, open-label, randomised study. Lung India 2022; 39:408-416. [PMID: 36629200 PMCID: PMC9623852 DOI: 10.4103/lungindia.lungindia_92_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/14/2023] Open
Abstract
Background We designed this randomised, open-label, parallel group, multi-centre study to investigate the efficacy and safety of glycopyrronium/formoterol, a long-acting muscarinic antagonist/long-acting β2-agonist fixed dose combination, delivered through a dry powder inhaler (DPI) in patients with chronic obstructive pulmonary disease (COPD). Material and Methods We randomised (1:1) patients with moderate to severe COPD (N = 356) to receive glycopyrronium 25 μg/formoterol 12 μg via DPI twice daily (GF-DPI) or glycopyrronium 50 μg monotherapy via DPI once daily (G-DPI). The primary study endpoint was the mean change from the baseline in pre-dose trough-forced expiratory volume in one second (FEV1) at 12 weeks. Results At week 12, the mean increase from the baseline in pre-dose trough FEV1 was higher in the GF-DPI group (120 ml) than in the G-DPI (60 ml) group. The mean difference (MD) between treatment groups was 0.06 L (95% CI: 0.00-0.12 L, P < 0.0001 for non-inferiority). At week 12, the mean pre-dose forced vital capacity (FVC), 1 hour post-dose FEV1, and post-dose FVC increased significantly from the baseline only in the GF-DPI group (p < 0.0001). The reduction in the COPD assessment test score was greater in the GF-DPI group (p = 0.0379). The average daily number of puffs of rescue medication and the reduction in mean modified Medical Research Council scale, COPD, and Asthma Sleep Impact Scale score at week 12 were similar between groups (p > 0.05). Overall, 35 adverse events and two serious adverse events unrelated to study drugs were reported. Both groups had similar results for overall drug safety. Conclusion The results demonstrate efficacy and safety of GF-DPI in Indian patients with moderate to severe COPD. Treatment with GF-DPI significantly improved the lung function and quality of life and was well tolerated.
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Affiliation(s)
- Sundeep Salvi
- Department of Pulmonology, Pulmocare Research and Education Faith Centre, Pune, Maharashtra, India
| | - Anand Kumar
- Department of Pulmonology, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Sumit Agrawal
- Department of Pulmonology, Oyster and Pearl Hospital, Pune, Maharashtra, India
| | - Amritlal Leuva
- Department of Chest and TB, Shree Sayaji General Hospital and Government Medical College, Vadodara, Gujarat, India
| | - Vineet Kumar Shukla
- Department of Pulmonology, KRM Hospital and Research Centre, Lucknow, Uttar Pradesh, India
| | - Shrikant Vishnu Deshpande
- Department of General Medicine, Dr. Deshpande’s Ashirwad Hospital and Research Center, Ulhasnagar, Maharashtra, India
| | - Santhalingam Balamurugan
- Department of Pulmonology, Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India
| | - Ajit Singh
- Department of Pulmonology, SMS Hospital and Medical College, Jaipur, Rajasthan, India
| | - Sharad Tikkiwal
- Department of Pulmonology, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Sandeep K. Gupta
- Department of Medicine, M.V. Hospital and Research Center, Lucknow, Uttar Pradesh, India
| | - Bhanu Pratap Singh
- Department of Pulmonary Medicine, Miland Healthcare, Lucknow, Uttar Pradesh, India
| | - Meena Lopez
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
| | - Sandesh Sawant
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
| | - Abhijit Vaidya
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
| | - Jaideep Gogtay
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
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Ghoshal A, Waghray P, Dsouza G, Saluja M, Agarwal M, Goyal A, Limaye S, Balki A, Bhatnagar S, Jain M, Tikkiwal S, Vaidya A, Lopez M, Hegde R, Gogtay J. Real-world evaluation of the clinical safety and efficacy of fluticasone/formoterol FDC via the Revolizer® in patients with persistent asthma in India. Pulm Pharmacol Ther 2019; 60:101869. [PMID: 31794836 DOI: 10.1016/j.pupt.2019.101869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022]
Abstract
The combination of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) is widely used for the management of asthma. This prospective, open-label, non-comparative, observational, 24-week multicentre study is the first real-world study from India to compare the efficacy and safety of fixed-dose combination of fluticasone/formoterol (Maxiflo® 100/6 mcg or 250/6 mcg) capsules via the Revolizer® device in patients with persistent asthma. The primary efficacy analyses included mean change in Asthma Control Test (ACT™) at 4, 8, 16 and 24 weeks. Secondary efficacy analyses included mean change in morning and evening peak expiratory flow rate (PEFR) at the end of 4, 8, 16 and 24 weeks, number of patients having symptom-free days and nights at the end of 4, 8, 16 and 24 weeks, the number and severity of exacerbations over 24 weeks and response to the Usability Preference Satisfaction Confidence questionnaire after 1 week. Overall, 385 (of 401; 96.01%) enrolled patients completed the study. The mean change in ACT™ score was 6.7 ± 3.71 (95% CI: 6.32, 7.06; p < 0.0001) at week 24. The ACT™ score at weeks 4, 8 and 16 showed progressive and statistically significant increase from baseline. A statistically significant improvement in morning and evening PEFR at weeks 4, 8, 16 and 24 was reported. The proportion of patients experiencing symptom-free days and nights continuously increased from baseline to week 24. A good safety profile over the 24-week period was observed. The Revolizer® device was preferred by 94.26% patients over their current device. Fluticasone propionate/formoterol fumarate FDC capsules administered via a single-dose dry powder inhaler ([DPI], (Revolizer®) offers a novel, well-tolerated and effective treatment option for the long-term management of asthma.
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Affiliation(s)
- Aloke Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, India.
| | | | - George Dsouza
- St. Johns Medical College and Hospital, Bengaluru, India.
| | | | | | | | | | - Akash Balki
- Shree Hospital and Critical Care, Nagpur, India.
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Jaggi V, Dalal A, Ramesh BR, Tikkiwal S, Chaudhry A, Kothari N, Lopez M, Gogtay J. Coexistence of allergic rhinitis and asthma in Indian patients: The CARAS survey. Lung India 2019; 36:411-416. [PMID: 31464213 PMCID: PMC6710977 DOI: 10.4103/lungindia.lungindia_491_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Asthma patients often suffer from concomitant allergic rhinitis (AR). However, there is paucity of such data from India. Aims This questionnaire-based survey evaluated the coexistence of AR in Indian asthmatics, and examined the inter-relationship between the two disease conditions. Subjects and Methods This survey conducted in ten cities across India, aimed to generate information on exposure to risk factors, history of atopy, the severity of asthma, and treatment regimen in patients with physician-diagnosed asthma. Results Data were obtained from 1161 asthma patients (mean age [±standard deviation]: 40.41 [±17.05] years). Prevalence of coexisting AR was found to be 65.24%, with the highest prevalence (80%) in the southern regions of India. Sneezing (71.78%) followed by watery, runny nose (63.59%) were the most common AR symptoms. Majority (72.32%) of the patients had seasonal AR. Coexistence of AR and asthma was significantly associated with the presence of personal and family history of atopy (odds ratio 2.53 and 1.51 respectively; both P < 0.005). Passive smoking, exposure to biomass fuel, and the presence of pets and animals at home were also significantly (P < 0.005) associated with AR-asthma coexistence. Prevalence of AR was found to increase with increasing asthma severity. The usage of oral steroids was significantly higher in patients with coexistent AR-asthma. Sixty-six percent of the patients with coexistent AR-asthma were prescribed intranasal corticosteroids. Conclusions The results of the Coexistence of Allergic Rhinitis and ASthma (CARAS) survey highlight the high prevalence of concomitant AR in Indian patients with asthma, and reinforce the need for early diagnosis and guideline-based management of AR in patients with asthma.
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Affiliation(s)
| | - Alpa Dalal
- Department of Pulmonology, Jupiter Hospital, Mumbai, Maharashtra, India
| | - B R Ramesh
- Department of Pulmonary and Sleep Medicine, Bhagwan Mahaveer Jain Hospital, Bengaluru, Karnataka, India
| | | | - Anil Chaudhry
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, Delhi, India
| | - Nisha Kothari
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
| | - Meena Lopez
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
| | - Jaideep Gogtay
- Department of Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India
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Dhar R, Salvi S, Rajan S, Dalal S, Tikkiwal S, Bhagat R, Ahmed MM, Balki A, Jain M, Gogtay J. Salmeterol/fluticasone through breath-actuated inhaler versus pMDI: a randomized, double-blind, 12 weeks study. J Asthma 2015; 52:1065-72. [PMID: 26288199 DOI: 10.3109/02770903.2015.1050499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Salmeterol/fluticasone combination (SFC) formulated in a breath-actuated inhaler (BAI) overcomes the co-ordination problem associated with the pressurized-metered dose inhaler (pMDIs). Our aim was to compare the efficacy and the safety of SFC given through the BAI versus the conventional pMDI in moderate-to-severe asthmatics. METHODS In this randomized, double-blind, double-dummy, prospective, active-controlled, parallel group, multicenter, 12 weeks study, 150 asthmatics were randomized to receive SFC (25/125 mcg) through either BAI or pMDI. The primary efficacy endpoint was mean change in pre-dose morning PEFR value at 12 weeks and the secondary efficacy endpoints included, mean change in FEV(1), pre-bronchodilator FVC, pre-dose morning and evening PEFR, symptom scores at 2, 4, 8, and 12 weeks. Patient preferences for device and safety were also assessed. RESULTS At 12 weeks, the mean change in pre-dose morning PEFR in BAI and pMDI groups was 50.72 L/min and 48.82 L/min, respectively (p < 0.0001; both groups) and the difference between the two groups was not significant. Both the treatment groups showed a statistically significant improvement in secondary endpoints at all-time points compared with baseline. The usability questionnaire assessment results showed that the BAI device was preferred by 75% of patients as compared with 25% preferring pMDI. SFC in both BAI and pMDI devices was found to be safe and well tolerated. CONCLUSION This is the first study to demonstrate that SFC given through the BAI produces comparable efficacy and safety endpoints as pMDI. Additionally, BAI was the preferred inhaler by patients compared to conventional pMDI.
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Affiliation(s)
- Raja Dhar
- a Department of Pulmonology and Critical Care , Fortis Hospital , Kolkata , India
| | | | | | | | | | - Raj Bhagat
- f Dr. Bhagat's Allergy - Asthma Clinic & Respiratory Care Centre , Ahmedabad , India
| | | | - Akash Balki
- h Shree Hospital and Critical Care Centre , Nagpur , India
| | - Manish Jain
- i Swaash Clinic, Navkar Hospital , Jaipur , India , and
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Singh S, Singh N, Tikkiwal S. Luftsichel sign. Lung India 2012; 29:83-4. [PMID: 22345924 PMCID: PMC3276045 DOI: 10.4103/0970-2113.92373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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