Loss of asthma control when patients receiving fluticasone propionate/salmeterol 100/50$mu;g DiskusS are ?stepped-down? to fluticasone propionate, salmeterol or montelukast alone*1

Keonig, S.; Waitkus-Edwards, Kelli; Yancey, Steve; Prillaman, Barbara A.; Dorinsky, Paul

doi:10.1016/j.jaci.2003.12.325

Cited by 9 publications

(3 citation statements)

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“…Of the included studies 17 have not been published as full-text journal articles (Hultquist 2000; SAM40008; SAM40012; SAS40024; SAS40036; SAS40037; SD 037 0344a; SD 037 0344b; SD 039 0714; SD 039 0718; SD 039 0719; SD 039 0725a; SD 039 0725b; SD 039 0728; SFA100316; SFCF4026; SMS40012).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-eight (36%) studies recruited adults exclusively (> 18 years); 24 (31%) recruited children and 21 (27% of trials) studies permitted the enrolment of an unspecified number of adolescents aged 12 years or more. In two trials the lower age cut-off was 15 years (SAS40036; SAS40037). In Houghton 2007 and SD 039 0349 the mean age suggested that the participants were predominantly adults with an unspecified age limit for enrolment.…”

Section: Resultsmentioning

confidence: 99%

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Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children

Ducharme

Chróinín

Greenstone

et al. 2010

Cochrane Database of Systematic Reviews

132

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Background Long-acting inhaled ß2-adrenergic agonists (LABAs) are recommended as ’add-on’ medication to inhaled corticosteroids (ICS) in the maintenance therapy of asthmatic adults and children aged two years and above. Objectives To quantify in asthmatic patients the safety and efficacy of the addition of LABAs to ICS in patients insufficiently controlled on ICS alone. Search methods We identified randomised controlled trials (RCTs) through electronic database searches (the Cochrane Airways Group Specialised Register, MEDLINE, EMBASE and CINAHL), bibliographies of RCTs and correspondence with manufacturers until May 2008. Selection criteria We included RCTs if they compared the addition of inhaled LABAs versus placebo to the same dose of ICS in children aged two years and above and in adults. Data collection and analysis Two review authors independently assessed studies for methodological quality and extracted data. We obtained confirmation from the trialists when possible. The primary endpoint was the relative risk (RR) of asthma exacerbations requiring rescue oral corticosteroids. Secondary endpoints included pulmonary function tests (PFTs), rescue beta2-agonist use, symptoms, withdrawals and adverse events. Main results Seventy-seven studies met the entry criteria and randomised 21,248 participants (4625 children and 16,623 adults). Participants were generally symptomatic at baseline with moderate airway obstruction despite their current ICS regimen. Formoterol or salmeterol were most frequently added to low-dose ICS (200 to 400 μg/day of beclomethasone (BDP) or equivalent) in 49% of the studies. The addition of a daily LABA to ICS reduced the risk of exacerbations requiring oral steroids by 23% from 15% to 11% (RR 0.77, 95% CI 0.68 to 0.87, 28 studies, 6808 participants). The number needed to treat with the addition of LABA to prevent one use of rescue oral corticosteroids is 41 (29, 72), although the event rates in the ICS groups varied between 0% and 38%. Studies recruiting adults dominated the analysis (6203 adult participants versus 605 children). The subgroup estimate for paediatric studies was not statistically significant (RR 0.89, 95% CI 0.58 to 1.39) and includes the possibility of the superiority of ICS alone in children. Higher than usual dose of LABA was associated with significantly less benefit. The difference in the relative risk of serious adverse events with LABA was not statistically significant from that of ICS alone (RR 1.06, 95% CI 0.87 to 1.30). The addition of LABA led to a significantly greater improvement in FEV1 (0.11 litres, 95% 0.09 to 0.13) and in the proportion of symptom-free days (11.88%, 95% CI 8.25 to 15.50) compared to ICS monotherapy. It was also associated with a reduction in the use of rescue short-acting ß2-agonists (−0.58 puffs/day, 95% CI −0.80 to −0.35), fewer withdrawals due to poor asthma control (RR 0.50, 95% CI 0.41 to 0.61), and fewer withdrawals due to any reason (RR 0.80, 95% CI 0.75 to 0.87). There was no statistically significant group difference ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children

Ducharme

Chróinín

Greenstone

et al. 2010

Cochrane Database of Systematic Reviews

132

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“…We found 5 randomized controlled trials that examined LABA step-off in patients with asthma compared with no change in use of LABAs and ICSs (Table 1). [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] Four studies were published in peer-reviewed journals 37,39,42,47 and 1 was available only as a conference abstract 50 and a report in the manufacturer's online register of studies. 51 All studies included adult or older adolescent patients with a 6-month or longer history of mild to moderate asthma (Table 1).…”

Section: Included Studiesmentioning

confidence: 99%

Long-Acting β₂-Agonist Step-off in Patients With Controlled Asthma

Brožek¹,

Kraft²,

Krishnan³

et al. 2012

Arch Intern Med

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Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children

Chauhan

Ducharme

2012

Cochrane Database of Systematic Reviews

187

107

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Background Anti-leukotrienes (5-lipoxygenase inhibitors and leukotriene receptors antagonists) serve as alternative monotherapy to inhaled corticosteroids (ICS) in the management of recurrent and/or chronic asthma in adults and children. Objectives To determine the safety and efficacy of anti-leukotrienes compared to inhaled corticosteroids as monotherapy in adults and children with asthma and to provide better insight into the influence of patient and treatment characteristics on the magnitude of effects. Search methods We searched MEDLINE (1966 to Dec 2010), EMBASE (1980 to Dec 2010), CINAHL (1982 to Dec 2010), the Cochrane Airways Group trials register, and the Cochrane Central Register of Controlled Trials (Dec 2010), abstract books, and reference lists of review articles and trials. We contacted colleagues and the international headquarters of anti-leukotrienes producers. Selection criteria We included randomised trials that compared anti-leukotrienes with inhaled corticosteroids as monotherapy for a minimum period of four weeks in patients with asthma aged two years and older. Data collection and analysis Two review authors independently assessed the methodological quality of trials and extracted data. The primary outcome was the number of patients with at least one exacerbation requiring systemic corticosteroids. Secondary outcomes included patients with at least one exacerbation requiring hospital admission, lung function tests, indices of chronic asthma control, adverse effects, withdrawal rates and biological inflammatory markers. Main results Sixty-five trials met the inclusion criteria for this review. Fifty-six trials (19 paediatric trials) contributed data (representing total of 10,005 adults and 3,333 children); 21 trials were of high methodological quality; 44 were published in full-text. All trials pertained to patients with mild or moderate persistent asthma. Trial durations varied from four to 52 weeks. The median dose of inhaled corticosteroids was quite homogeneous at 200 μg/day of microfine hydrofluoroalkane-propelled beclomethasone or equivalent (HFABDP eq). Patients treated with anti-leukotrienes were more likely to suffer an exacerbation requiring systemic corticosteroids (N = 6077 participants; risk ratio (RR) 1.51, 95% confidence interval (CI) 1.17, 1.96). For every 28 (95% CI 15 to 82) patients treated with anti-leukotrienes instead of inhaled corticosteroids, there was one additional patient with an exacerbation requiring rescue systemic corticosteroids. The magnitude of effect was significantly greater in patients with moderate compared with those with mild airway obstruction (RR 2.03, 95% CI 1.41, 2.91 versus RR 1.25, 95% CI 0.97, 1.61), but was not significantly influenced by age group (children representing 23% of the weight versus adults), anti-leukotriene used, duration of intervention, methodological quality, and funding source. Significant group differences favouring inhaled corticosteroids were noted in most secondary outcomes including patients with at least one e...

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Loss of asthma control when patients receiving fluticasone propionate/salmeterol 100/50$mu;g DiskusS are ?stepped-down? to fluticasone propionate, salmeterol or montelukast alone*1

Cited by 9 publications

References 0 publications

Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children

Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children

Long-Acting β₂-Agonist Step-off in Patients With Controlled Asthma

Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children

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Loss of asthma control when patients receiving fluticasone propionate/salmeterol 100/50$mu;g DiskusS are ?stepped-down? to fluticasone propionate, salmeterol or montelukast alone*1

Cited by 9 publications

References 0 publications

Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children

Addition of long-acting beta2-agonists to inhaled corticosteroids versus same dose inhaled corticosteroids for chronic asthma in adults and children

Long-Acting β2-Agonist Step-off in Patients With Controlled Asthma

Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children

Contact Info

Product

Resources

About

Long-Acting β₂-Agonist Step-off in Patients With Controlled Asthma