Effect of the addition of montelukast to fluticasone propionate for the treatment of perennial allergic rhinitis

Esteitie, Rania; deTineo, Marcy; Naclerio, Robert M.; Baroody, Fuad M.

doi:10.1016/j.anai.2010.05.017

Cited by 36 publications

(49 citation statements)

References 25 publications

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“…24 In fact, as many as 70.5% of moderate/severe SAR patients in the United Kingdom use multiple therapies in an effort to achieve this complete and fast symptom relief, 5 even though there is no scientific evidence to support that practice. 25,26 Data collected during this study also serve to highlight the suboptimal symptom relief afforded by the most frequently prescribed medications (i.e., antihistamines and INS) even if used together and the need for a more effective treatment option. The inadequacy of currently considered first-line AR treatments was apparent not only by the high physician consultation rate and by the frequency of comedication use, but also by patients' high VAS scores at baseline.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: Results from a noninterventional study

Klimek

Bachert²,

Mösges³

et al. 2015

allergy asthma proc

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The efficacy of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) has been well established in controlled clinical trials. This study was designed to assess the use of MP29-02 and its effectiveness in routine clinical practice. This was a German multicenter, prospective, noninterventional study, including 1781 allergic rhinitis (AR) patients. Eligible patients (i.e., acute AR symptoms and visual analog scale [VAS] score >50 mm) were included, assigned MP29-02 at baseline, and reassessed after ∼14 days. Patients assessed symptom control using a VAS from 0 (not at all bothersome) to 100 mm (very bothersome) in the morning before MP29-02 use, on days 0, 1, 3, and 7 and after ∼ 14 days. Patients' perceived levels of disease control were assessed on day 3. The Youden index determined patient-reported VAS score cutoffs on day 3 for "well controlled" and "partly controlled." MP29-02 reduced the VAS score from 75.4 mm (SD = 17.2) at baseline to 21.3 mm (SD = 18.3) by the last visit, a shift of 54.1 mm (SD = 24.6). One in every two patients felt their symptoms were well controlled at day 3. This perception of well-controlled symptoms at day 3 corresponded to an optimal VAS cutoff of 36 mm. On average, patients treated with MP29-02 crossed this well-controlled VAS cutoff by last visit. Similar results were found in adolescents, adults, and older adults, in those with perennial AR (PAR), seasonal AR (SAR), or PAR + SAR and in those with more and less severe disease. MP29-02 provides effective and rapid symptom control across all age groups in a real-life setting with responder rates higher than those observed in controlled clinical trials, supporting MP29-02's position as the drug of choice for the treatment for AR.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: Results from a noninterventional study

Klimek

Bachert²,

Mösges³

et al. 2015

allergy asthma proc

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“…However, this combination is not supported by clinical trials of combination regimens vs. monotherapy. 21,22 The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines state that “combination between drugs has been tested, but insufficient data are available to make a recommendation concerning the combined use of oral AH and INCS”. 23 …”

Section: Ar Management In the Ukmentioning

confidence: 99%

An algorithm recommendation for the pharmacological management of allergic rhinitis in the UK: a consensus statement from an expert panel

Lipworth

Newton

Ram

et al. 2017

npj Prim Care Resp Med

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Allergic rhinitis is a frequent presenting problem in primary care in the UK, and has increased in prevalence over the last 30 years. When symptomatic, patients report significant reduction in their quality of life and impairment in school and work performance. Achieving adequate symptom control is pivotal to successful allergic rhinitis management, and relies mostly on pharmacotherapy. While it is recognised that most mild-moderate allergic rhinitis symptoms can be managed successfully in primary care, important gaps in general practitioner training in relation to allergic rhinitis have been identified. With the availability of new effective combination therapies, such as the novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in a single device (Dymista®; Meda), the majority of allergic rhinitis symptoms can be treated in the primary care setting. The primary objective of this consensus statement is to improve diagnosis and treatment of allergic rhinitis in primary care, and offer guidance on appropriate referral of difficult-to-treat patients into secondary care. The guidance provided herein outlines a sequential treatment pathway for allergic rhinitis in primary care that incorporates a considered approach to improve the management of allergic rhinitis symptoms and improve compliance and patient satisfaction with therapy. Adherence with this care pathway has the potential to limit the cost of providing effective allergic rhinitis management in the UK by avoiding unnecessary treatments and investigations, and avoiding the need for costly referrals to secondary care in the majority of allergic rhinitis cases. The fundamentals presented in this consensus article should apply in most health-care settings.

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“…Second-generation OAHs are considered first-line therapy for mild intermittent AR, as they require once daily dosing and have a faster onset of action and fewer adverse effects than first-generation OAHs. According to ARIA, there is insufficient evidence to recommend the combined use of OAHs and INCSs, with most of the published studies showing no benefits gained by adding other AR treatments to INCS therapy 3,17,18…”

Section: Introductionmentioning

confidence: 99%

Medication-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy purchases

Smith¹,

Price²,

Harvey³

et al. 2017

JAA

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PurposeThere is a relative paucity of research regarding medication expenditure associated with multiple-therapy use for rhinitis in Australia. To describe 1) the nature and extent of multiple-therapy use for rhinitis in Australia using data on therapies purchased with prescription or over-the-counter (OTC) and 2) additional costs incurred by multiple-therapy use compared with intranasal corticosteroid (INCS) therapy alone.Patients and methodsA retrospective observational study was carried out using a database containing anonymous pharmacy transaction data available from 20% of pharmacies in Australia that links doctor prescriptions and OTC purchase information. Pharmacy purchases of at least one prescription or OTC rhinitis treatment, with or without additional asthma/chronic obstructive pulmonary disease (COPD) therapy, by patients during 2013 and 2014 were assessed.ResultsIn total, 4,247,193 prescription and OTC rhinitis treatments were purchased from 909 pharmacies over 24 months. The majority of rhinitis therapy transactions were single-therapy purchases without additional asthma/COPD therapy. Of the single therapies purchased, 73% were oral antihistamines (OAHs) and 15% were INCS therapy. Dual-therapy purchases of INCSs and OAHs accounted for 40% of multiple-therapy purchases. Patients frequently purchased OAHs, nonsteroidal nasal sprays, and eye drops for allergic conjunctivitis alongside INCSs, resulting in higher financial costs (up to AU$21 per treatment episode) compared with INCS monotherapy.ConclusionThis study highlighted the significant burden posed on community pharmacy to address the needs of people with rhinitis symptoms, and the failure to translate the evidence that INCSs are the most effective monotherapy for moderate to severe and/or persistent rhinitis into clinical practice in light of the lack of evidence supporting combination of INCS and OAH therapy. Health care professional engagement, especially at the pharmacy level, will be extremely important if we wish to ensure that the purchase of rhinitis treatment is in accordance with guidelines and that their use is optimal.

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Effect of the addition of montelukast to fluticasone propionate for the treatment of perennial allergic rhinitis

Cited by 36 publications

References 25 publications

Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: Results from a noninterventional study

Effectiveness of MP29-02 for the treatment of allergic rhinitis in real-life: Results from a noninterventional study

An algorithm recommendation for the pharmacological management of allergic rhinitis in the UK: a consensus statement from an expert panel

Medication-related costs of rhinitis in Australia: a NostraData cross-sectional study of pharmacy purchases

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