Analysis Group, Boston, Massachusetts 02199-7636, USA.
Clin Ther. 2009 Dec;31(12):2779-803. doi: 10.1016/j.clinthera.2009.12.021.
BACKGROUND: Inhaled corticosteroids (ICSs) and long-acting inhaled beta(2)-agonists (LABAs) are recommended treatment options for asthma. OBJECTIVE: This review compares the clinical effectiveness and tolerability of the ICSs fluticasone propionate and budesonide and the LABAs formoterol fumarate and salmeterol xinafoate administered alone or in combination. METHODS: A systematic review of the clinical studies available on MEDLINE (database period, 1950-September 2009) was conducted to assess English-language randomized controlled trials in children and adults with asthma. Treatment outcomes included lung function, symptom-free days (SFDs), use of rescue/reliever medications, asthma exacerbations, and tolerability profile. RESULTS: Use of fluticasone was associated with significantly greater improvement in lung function and better asthma symptom control than budesonide. Similarly, formoterol was associated with significantly greater improvement in lung function and better asthma symptom control (as measured by less rescue medication use and more SFDs) compared with salmeterol. Single inhaler combination regimens (budesonide/ formoterol and fluticasone/salmeterol) were frequently more effective in improving all treatment outcomes than either monotherapy alone. Across all comparisons, a review of studies in adults and children did not find statistically significant differences in outcomes between the ICS and LABA therapies considered in this research. In general, no differences in tolerability profiles were reported between the ICS and LABA options, although the risk for growth retardation was lower with fluticasone than budesonide and with budesonide/formoterol than with budesonide monotherapy. CONCLUSIONS: In this systematic review, fluticasone and formoterol appear to provide improved therapeutic benefits versus budesonide and salmeterol, respectively. Both fluticasone/salmeterol and budesonide/ formoterol combination therapies appeared to be associated with greater improvements in outcomes measures than the corresponding ICS and LABA monotherapies.
背景：吸入性皮质类固醇（ICSs）和长效吸入型β2-受体激动剂（LABAs）是推荐的哮喘治疗选择。 目的：本综述比较了 ICSs 丙酸氟替卡松和布地奈德，以及 LABA 富马酸福莫特罗和沙美特罗的临床疗效和耐受性，这些药物单独或联合使用。 方法：对 MEDLINE 上可用的临床研究进行系统回顾（数据库时期为 1950 年-2009 年 9 月），以评估治疗儿童和成人哮喘的英语随机对照试验。治疗结果包括肺功能、无症状天数（SFDs）、急救/缓解药物的使用、哮喘恶化以及耐受性概况。 结果：与布地奈德相比，使用氟替卡松与肺功能显著改善和哮喘症状控制更好相关。同样，与沙美特罗相比，福莫特罗使用与肺功能显著改善和哮喘症状控制更好（表现为使用急救药物减少和无症状天数增加）相关。与单药治疗相比，布地奈德/福莫特罗和氟替卡松/沙美特罗等单一吸入联合方案通常在改善所有治疗结果方面更有效。在所有比较中，对成人和儿童研究的综述发现，在所研究的 ICS 和 LABA 疗法之间，结果没有统计学上的显著差异。一般来说，ICS 和 LABA 方案之间的耐受性概况没有差异，尽管与布地奈德相比，氟替卡松发生生长迟缓的风险较低，与布地奈德/福莫特罗相比，布地奈德单药治疗发生生长迟缓的风险较低。 结论：在本系统综述中，与布地奈德和沙美特罗相比，氟替卡松和福莫特罗似乎提供了更好的治疗益处。氟替卡松/沙美特罗和布地奈德/福莫特罗联合治疗方案似乎与改善治疗结果的措施比相应的 ICS 和 LABA 单药治疗方案更相关。
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