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每日一次糠酸氟替卡松对接受低剂量吸入皮质激素治疗、有症状的哮喘患者有效。

Once-daily fluticasone furoate is efficacious in patients with symptomatic asthma on low-dose inhaled corticosteroids.

机构信息

Center for Genomics and Personalized Medicine, Wake Forest University Health Sciences Winston-Salem, North Carolina, USA.

出版信息

Ann Allergy Asthma Immunol. 2012 Nov;109(5):353-358.e4. doi: 10.1016/j.anai.2012.08.017.

Abstract

BACKGROUND

Fluticasone furoate (FF) is an inhaled corticosteroid (ICS) with 24-hour activity in development as a once-daily treatment for the long-term management of asthma.

OBJECTIVE

To assess the efficacy and safety of 4 doses of once-daily FF administered using a dry powder inhaler in patients (≥12 years) with moderate asthma, uncontrolled on low-dose ICS (fluticasone propionate [FP] 200 μg/day or equivalent).

METHODS

This double-blind, placebo-controlled, dose-ranging study randomized 622 patients to 1 of 6 treatments: FF (100, 200, 300, or 400 μg) once daily in the evening, FP 250 μg twice daily (active control), or placebo for 8 weeks. The primary endpoint was the change from baseline in predose evening forced expiratory colume in 1 second (FEV1) at week 8.

RESULTS

At week 8, relative to placebo, all doses of FF once daily and FP twice daily demonstrated significantly (P < .001) greater increases from baseline and greater than 200-mL increases in predose FEV1. There was no evidence of a dose-response relationship between FF doses. Improvement with once-daily FF was similar to or greater than that for twice-daily FP. Secondary efficacy endpoint findings generally supported the efficacy of FF 100 to 400 μg once daily, although statistically significant improvements versus placebo in symptom-free 24-hour periods were only reported for FF 400 μg. There were few withdrawals due to lack of efficacy. Oral candidiasis was reported in 0 to 4% of patients; 24-hour urinary cortisol excretion ratios were similar across active treatment groups and not significantly different from placebo.

CONCLUSION

FF 100 to 400 μg once daily in the evening is effective and well tolerated in patients with asthma uncontrolled on low-dose ICS, with 100 μg and 200 μg, considered the most applicable doses in this asthma population.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00603278.

摘要

背景

氟替卡松糠酸酯(FF)是一种具有 24 小时活性的吸入性皮质类固醇(ICS),作为一种每日一次的治疗方案,用于哮喘的长期管理。

目的

评估每日一次使用干粉吸入器给予 4 种剂量的氟替卡松糠酸酯(FF)在中重度哮喘患者(接受低剂量 ICS[丙酸氟替卡松(FP)200μg/天或等效剂量]治疗但未得到控制的患者)中的疗效和安全性。

方法

这项双盲、安慰剂对照、剂量范围研究将 622 例患者随机分为 6 种治疗组之一:每日一次晚上给予 FF(100、200、300 或 400μg)、每日两次 FP 250μg(阳性对照)或安慰剂,治疗 8 周。主要终点为第 8 周时预剂量晚上 1 秒用力呼气容积(FEV1)的基线变化。

结果

第 8 周时,与安慰剂相比,FF 每日一次所有剂量和 FP 每日两次均显著(P<0.001)增加了预剂量 FEV1,且增加量均超过 200mL。FF 剂量之间无剂量反应关系。FF 每日一次的改善与 FP 每日两次相似或更大。次要疗效终点的结果普遍支持 FF 100 至 400μg 每日一次的疗效,尽管仅报告了 FF 400μg 组在无症状 24 小时期间具有统计学显著改善。因疗效不佳而停药的患者很少。口腔念珠菌病的发生率为 0 至 4%;各活性治疗组的 24 小时尿皮质醇排泄比值相似,与安慰剂无显著差异。

结论

在接受低剂量 ICS 治疗但未得到控制的哮喘患者中,晚上给予氟替卡松糠酸酯 100 至 400μg 每日一次是有效且耐受良好的,100μg 和 200μg 被认为是该哮喘人群中最适用的剂量。

试验注册

clinicaltrials.gov 标识符:NCT00603278。

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