Inhaled corticosteroids or long-acting β-agonists alone or in fixed-dose combinations in asthma treatment: A systematic review of fluticasone/budesonide and formoterol/salmeterol

• Published in: Clinical therapeutics 2009-12, Vol.31 (12), p.2779-2803
• Main Authors: Frois, Christian, PhD, Wu, Eric Q., PhD, Ray, Saurabh, PhD, Colice, Gene L., MD
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adrenergic beta-Agonists - administration & dosage; Adrenergic beta-Agonists - adverse effects; Adrenergic beta-Agonists - therapeutic use; Adult; Albuterol - administration & dosage; Albuterol - adverse effects; Albuterol - analogs & derivatives; Albuterol - therapeutic use; Androstadienes - administration & dosage; Androstadienes - adverse effects; Androstadienes - therapeutic use; Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - adverse effects; Anti-Asthmatic Agents - therapeutic use; asthma; Asthma - drug therapy; Asthma - physiopathology; Biological and medical sciences; Child; Chronic obstructive pulmonary disease, asthma; Drug Combinations; Ethanolamines - administration & dosage; Ethanolamines - adverse effects; Ethanolamines - therapeutic use; Evidence-Based Medicine; Fluticasone-Salmeterol Drug Combination; Formoterol Fumarate; Humans; inhaled corticosteroids; inhaled long-acting beta 2-agonists; Internal Medicine; Lung - drug effects; Lung - physiopathology; Medical Education; Medical sciences; Nebulizers and Vaporizers; Pharmacology. Drug treatments; Pneumology; Practice Guidelines as Topic; Respiratory Function Tests; Risk Assessment; Salmeterol Xinafoate; Time Factors; Treatment Outcome
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2009.12.021

Abstract Background: Inhaled corticosteroids (ICSs) and longacting inhaled β2 -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.