Lötvall Jan, Bleecker Eugene R, Busse William W, O'Byrne Paul M, Woodcock Ashley, Kerwin Edward M, Stone Sally, Forth Richard, Jacques Loretta, Bateman Eric D
Krefting Research Centre, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden.
Center for Genomics and Personalized Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Respir Med. 2014 Jan;108(1):41-9. doi: 10.1016/j.rmed.2013.11.009. Epub 2013 Nov 19.
Inhaled corticosteroids (ICSs) improve asthma disease control; once-daily ICS administration may have advantages for patients. Our objective was to assess the efficacy and safety of the novel ICS fluticasone furoate (FF) over 24 weeks versus placebo. This was a 24-week double-blind, double-dummy, placebo- and active-controlled study (NCT01159912) of 343 asthma patients (≥12 years) not controlled by their current ICS. Patients were randomised (1:1:1) to FF100 μg, placebo (both administered once-daily [OD] via ELLIPTA™ dry powder inhaler in the evening) or fluticasone propionate (FP) 250 μg (administered twice-daily (BD) via DISKUS™/ACCUHALER™). Primary endpoint was change from baseline in pre-dose evening forced expiratory volume in 1s (FEV1) at Week 24; change from baseline in % rescue-free 24-h periods was a powered secondary endpoint. Adverse events (AEs) were assessed. FF100 μg OD and FP250 μg BD significantly improved pre-dose evening FEV1 compared with placebo at Week 24 (+146 ml [p = 0.009] and +145 ml [p = 0.011], respectively). Percentage of rescue-free 24-h periods was increased with FF100 μg OD (+14.8%) and FP250 μg BD (+17.9%) compared to placebo (both p < 0.001). On-treatment AEs were reported by 53% (FF100 μg OD), 42% (FP250 μg BD) and 40% (placebo) of patients. On-treatment severe asthma exacerbations were lower with FF100 μg OD (3%) and FP250 μg BD (2%) than placebo (7%). There was significant suppression of urinary cortisol at week 24 with FF100 μg OD (p = 0.030) and FP250 μg BD (p = 0.036) relative to placebo. FF100 μg OD, administered in the evening, achieves significant improvements in lung function and rescue inhaler use over 24 weeks, comparable to FP250 μg BD with similar safety profile.
吸入性糖皮质激素(ICSs)可改善哮喘疾病控制情况;每日一次使用ICS对患者可能具有优势。我们的目的是评估新型ICS糠酸氟替卡松(FF)在24周内相对于安慰剂的疗效和安全性。这是一项针对343例(≥12岁)目前使用的ICS无法控制病情的哮喘患者进行的为期24周的双盲、双模拟、安慰剂对照和活性药物对照研究(NCT01159912)。患者被随机分为三组(1:1:1),分别接受100μg FF、安慰剂(均通过ELLIPTA™干粉吸入器在晚上每日一次[OD]给药)或250μg丙酸氟替卡松(FP)(通过DISKUS™/ACCUHALER™每日两次[BD]给药)。主要终点是第24周时给药前晚上1秒用力呼气容积(FEV1)相对于基线的变化;无急救药物使用的24小时时间段相对于基线的变化是一个有统计学效力的次要终点。对不良事件(AE)进行了评估。在第24周时,与安慰剂相比,100μg FF OD和250μg FP BD均显著改善了给药前晚上的FEV1(分别增加146ml [p = 0.009]和145ml [p = 0.011])。与安慰剂相比,100μg FF OD(增加14.8%)和250μg FP BD(增加17.9%)使无急救药物使用的24小时时间段的比例升高(均p < 0.001)。分别有53%(100μg FF OD)、42%(250μg FP BD)和40%(安慰剂)的患者报告了治疗期间出现的AE。100μg FF OD(3%)和250μg FP BD(2%)治疗期间严重哮喘发作的发生率低于安慰剂组(7%)。与安慰剂相比,第24周时100μg FF OD(p = 0.030)和250μg FP BD(p = 0.036)对尿皮质醇有显著抑制作用。晚上使用100μg FF OD在24周内可显著改善肺功能和减少急救吸入器的使用,与250μg FP BD相当,且安全性相似。
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