Effects of low- versus high-dose fluticasone propionate/formoterol fumarate combination therapy on AMP challenge in asthmatic patients: A double-blind, randomised clinical trial

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• 作者：Frank Kanniess^a ; ^{f.kanniess@gpr-reinfeld.de" class="auth_mail" title="E-mail the corresponding author} ; Zuzana Diamant^b ; ^c ; ^d ; ^{z.diamant@gems.demon.nl" class="auth_mail" title="E-mail the corresponding author} ; Mark Lomax^e ; ^{Mark.Lomax@mundipharma-rd.eu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Asthma ; Fluticasone propionate ; Formoterol fumarate ; ICS/LABA ; AMP bronchoprovocation test ; Dose-response
• 刊名：Pulmonary Pharmacology & Therapeutics
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：37
• 期：Complete
• 页码：65-72
• 全文大小：734 K

文摘

The dose-response relationship between two dose levels of fluticasone/formoterol (flutiform^®, 100/10 μg and 500/20 μg) was evaluated in asthmatic patients. Non-invasive inflammatory markers were used including adenosine monophosphate (AMP) challenge (primary endpoint), and sputum eosinophils and fractional exhaled nitric oxide (FeNO) (secondary endpoints).

Methods

Patients aged ≥18 years with forced expiratory volume in 1 s (FEV₁) ≥60% predicted and who required a dose of <60 mg AMP to elicit a 20% drop in FEV₁ (AMP PD₂₀) were randomised in this incomplete block, crossover study to receive 2 of 3 treatments b.i.d.: fluticasone/formoterol 500/20 μg (high dose), 100/10 μg (low dose) or placebo, during 2 periods of 28 ± 3 days each, separated by 2–3 weeks. AMP challenges were performed pre-dose and 12 h after last dose at the end of each treatment period. A series of post hoc analyses were performed only in patients allocated to both fluticasone/formoterol doses, who completed the study and had evaluable AMP PD₂₀ data for both treatments (“fluticasone/formoterol subgroup”). Changes in AMP PD₂₀ FEV₁, percentage sputum eosinophils and FeNO levels (Day 1 vs Day 28) between treatments were compared by an analysis of covariance (ANCOVA).

Results

Sixty-two patients were randomised and 46 completed the study. Fifteen patients received both high- and low-dose fluticasone/formoterol (post hoc subgroup). The difference in AMP PD₂₀ for the overall population was not statistically significant between high- and low-dose fluticasone/formoterol (LS mean fold difference: 1.3; p = 0.489), although both dose levels were superior to placebo: high-dose vs placebo LS mean fold difference: 4.4, p < 0.001; low-dose vs placebo LS mean fold difference: 3.5, p < 0.001. In the post hoc subgroup, the difference in AMP PD₂₀ between the doses was statistically significant in favour of the high-dose (LS mean fold difference: 2.4, p = 0.012). Other inflammatory parameters (sputum eosinophil counts and FeNO) showed small differences and statistically non-significant changes between high- and low-dose fluticasone/formoterol.

Conclusions

A significant dose-response was found between low- and high-dose fluticasone/formoterol in the post hoc subgroup (patients who received both doses), but not in the overall population, with the higher dose demonstrating a greater reduction in airway responsiveness to AMP.