Once-daily fluticasone furoate and vilanterol for adolescents and adults with symptomatic asthma A systematic review with meta-analysis
Por:
Rodrigo, GJ, Plaza, V
Publicada:
1 jun 2016
Resumen:
Background: Fluticasone furoate and vilanterol is a new inhaled corticosteroid (ICS) and long-acting beta 2-agonist (LABA) combination developed for once-daily administration via a dry powder inhaler.
Objective: To assess the efficacy and safety of fluticasone furoate-vilanterol in adolescents and adults with symptomatic asthma compared with ICS monotherapy or twice-daily ICS-LABA formulations.
Methods: Randomized, placebo-controlled trials with longer than 8 weeks of treatment duration were included. Primary outcome was pulmonary function (forced expiratory volume in 1 second [FEV1] or peak expiratory flow rate [PEF]).
Results: Seven published randomized clinical trials were included (5,668 patients). Fluticasone furoate-vilanterolwas associated with significant increases in trough FEV1 and morning and evening PEF compared with fluticasone furoate, 100 mu g, monotherapy (90 mL, 20.1 L/min, and 18.9 L/min respectively). Fluticasone furoate-vilanterol reduced significantly the rate of severe asthma exacerbations (number need to treat for benefit = 24). Fluticasone furoate-vilanterol also produced significant increases in weighted FEV1 and morning and evening PEF (140 mL, 32.6 L/min, and 25.7 L/min, respectively) compared with fluticasone propionate, 500 mu g twice daily. Fluticasone furoate-vilanterol presented a nonsignificant increase in the frequency of cardiac events (6.4% vs 1.8%) compared with fluticasone propionate. No differences were found between both available doses of fluticasone furoate-vilanterol (200/25 mg and 100/25 mg) in terms of efficacy. However, patients receiving fluticasone furoate-vilanterol, 200/25 mg, had a trend toward an increased risk of cardiac events.
Conclusion: Fluticasone furoate-vilanterol combination was associated with an increase in trough FEV1 compared with fluticasone furoate-fluticasone propionate; however, observed differences may not be clinically significant. Studies comparing fluticasone furoate-vilanterol with fixed twice-daily ICS-LABA combinations are required. (C) 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Filiaciones:
Rodrigo, GJ:
Hosp Cent Fuerzas Armadas, Dept Emergencia, Av 8 Octubre 3020, Montevideo 11300, Uruguay
Plaza, V:
Hosp Santa Creu & Sant Pau, Dept Resp Med, Barcelona, Spain
Univ Autonoma Barcelona, IIB St Pau, E-08193 Barcelona, Spain
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