Efficacy and Safety of Budesonide and Formoterol in One Pressurised Metered-Dose Inhaler in Adults and Adolescents with Moderate to Severe Asthma
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- Noonan, M., Rosenwasser, L.J., Martin, P. et al. Drugs (2006) 66: 2235. doi:10.2165/00003495-200666170-00006
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Background: Inhaled corticosteroids (ICSs) are the preferred maintenance therapy for adults and children with mild, moderate and severe persistent asthma, with the addition of a long-acting β2-adrenoceptor agonist to ICS therapy recommended for patients with moderate or severe persistent asthma. The efficacy and safety of the combination of budesonide and formoterol delivered via dry powder inhaler (DPI) is well documented.
Objective: To compare the efficacy and safety of budesonide/formoterol pressurised metered-dose inhaler (budesonide/formoterol pMDI; Symbicort™ pMDI, AstraZeneca LP, Wilmington, DE, USA) with budesonide pMDI (Pulmicort® pMDI, AstraZeneca, Lund, Sweden), formoterol DPI (Oxis® Turbuhaler®, AstraZeneca, Lund, Sweden), budesonide plus formoterol in separate inhalers (budesonide pMDI + formoterol DPI) and placebo.
Study design: This was a 12-week randomised, double-blind, double-dummy, placebo-controlled study.
Setting: This multicentre study was conducted in the respiratory specialty clinical practice setting.
Patients: The study included 596 patients ≥12 years of age with moderate to severe persistent asthma previously receiving ICSs.
Interventions: After 2 weeks on budesonide pMDI 80µg × two inhalations (160μg) twice daily, patients received budesonide/formoterol pMDI 160μg/4.5μg × two inhalations (320μg/9μg); budesonide pMDI 160μg × two inhalations (320μg) + formoterol DPI 4.5μg × two inhalations (9μg); budesonide pMDI 160μg × two inhalations (320μg); formoterol DPI 4.5μg × two inhalations (9μg); or placebo twice daily.
Main outcome measures: There were two prespecified primary efficacy variables: mean change from baseline in morning predose forced expiratory volume in 1 second (FEV1), obtained approximately 12 hours after the most recent administration of study medication at home and immediately before the next administration of study medication at the clinic; and mean change from baseline in 12-hour FEV1, assessed as the average change in FEV1 from serial spirometry over the 12-hour period after administration of the morning dose of study medication at the clinic.
Results: Mean changes from baseline in morning predose FEV1 at end of treatment were greater (p ≤ 0.049) with budesonide/formoterol pMDI (0.19L) versus budesonide pMDI (0.10L), formoterol DPI (−0.12L) and placebo (−0.17L). Mean changes from baseline in 12-hour FEV1 were greater (p ≤ 0.001) with budesonide/formoterol pMDI after 1 day (0.37L), 2 weeks (0.34L) and at end of treatment (0.37L) versus budesonide pMDI (0.11, 0.15 and 0.15L) and placebo (0.09, −0.03 and −0.03L), and after 2 weeks and at end of treatment versus formoterol DPI (0.19 and 0.17L). Fewer (p ≤ 0.025) patients receiving budesonide/formoterol pMDI versus monoproducts or placebo met worsening asthma criteria. Results were similar in the budesonide/formoterol pMDI group and the budesonide pMDI + formoterol DPI group on all measures. All treatments were well tolerated with similar safety profiles.
Conclusions: In this population, twice-daily budesonide/formoterol pMDI provides asthma control significantly greater than the monocomponents or placebo and comparable with budesonide pMDI + formoterol DPI. Safety profiles were similar for all treatments.