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Fluticasone propionate versus zafirlukast: effect in patients previously receiving inhaled corticosteroid therapy.
Ann Allergy Asthma Immunol. 2000 Nov; 85(5):398-406.AA

Abstract

BACKGROUND

The use of inhaled corticosteroids compared with leukotriene modifying drugs in the treatment of persistent asthma has not been extensively studied.

OBJECTIVE

To compare the efficacy and safety of a low dose of fluticasone propionate (FP) and zafirlukast in patients previously maintained on inhaled corticosteroids.

METHODS

Patients (> or = 12 years old; FEV1 = 60% to 85% of predicted) with persistent asthma who were previously treated with low doses of triamcinolone acetonide (TAA) 400 to 800 microg/day or beclomethasone dipropionate (BDP) 168 to 336 microg/day were randomized to treatment with FP aerosol 88 microg BID (FP, n = 221) or zafirlukast 20 mg BID (n = 216) over 6 weeks.

RESULTS

Treatment with FP significantly increased the mean change at endpoint (the last post-baseline observation) in FEV1 (0.22 L versus 0.03 L, P < .001), morning PEF (17.8 versus 3.1 L/min, P = .004), evening PEF (16.7 versus 2.6 L/min, P = .002), the percentage of symptom-free days (16.2 versus 7.1%, P = .007), and the percentage of rescue-free days (23.4 versus 9.3%, P < .001), and significantly decreased rescue albuterol use (-0.66 puffs/day versus an increase of 0.27 puffs/day, P < .001) and combined symptom scores (-0.13 versus an increase of 0.08, P < .001) compared with zafirlukast. Treatment with FP maintained the percentage of awakening-free nights (-1.0 +/- 1.0); in contrast, treatment with zafirlukast reduced the percentage of awakening-free nights (-9.0 +/- 1.6, P < .001). A clinically meaningful difference (change of > or = 0.5; P < .001) was observed between FP and zafirlukast in the Asthma Quality of Life Questionnaire (AQLQ) global score and for each domain score except activity limitation (change of 0.3, P < .001). Significantly more patients in the zafirlukast group experienced an asthma exacerbation (n = 14) compared with FP-treated patients (n = 5, P = .035). Patients in the zafirlukast group were significantly more likely to be withdrawn due to lack of efficacy (P < .001).

CONCLUSION

Switching patients from low doses of inhaled corticosteroids to a lower total microgram dose of FP improves pulmonary function, asthma symptoms, and quality of life, while switching to the leukotriene receptor antagonist zafirlukast may result in worsening of asthma control. This was indicated by the significant number of zafirlukast-treated patients who were dropped from the study due to lack of efficacy within 6 weeks of discontinuing inhaled corticosteroids.

Authors+Show Affiliations

Allergy, Asthma and Respiratory Care Center, Inc, Long Beach, California 90806, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11101185

Citation

Kim, K T., et al. "Fluticasone Propionate Versus Zafirlukast: Effect in Patients Previously Receiving Inhaled Corticosteroid Therapy." Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, vol. 85, no. 5, 2000, pp. 398-406.
Kim KT, Ginchansky EJ, Friedman BF, et al. Fluticasone propionate versus zafirlukast: effect in patients previously receiving inhaled corticosteroid therapy. Ann Allergy Asthma Immunol. 2000;85(5):398-406.
Kim, K. T., Ginchansky, E. J., Friedman, B. F., Srebro, S., Pepsin, P. J., Edwards, L., Stanford, R. H., & Rickard, K. (2000). Fluticasone propionate versus zafirlukast: effect in patients previously receiving inhaled corticosteroid therapy. Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, 85(5), 398-406.
Kim KT, et al. Fluticasone Propionate Versus Zafirlukast: Effect in Patients Previously Receiving Inhaled Corticosteroid Therapy. Ann Allergy Asthma Immunol. 2000;85(5):398-406. PubMed PMID: 11101185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluticasone propionate versus zafirlukast: effect in patients previously receiving inhaled corticosteroid therapy. AU - Kim,K T, AU - Ginchansky,E J, AU - Friedman,B F, AU - Srebro,S, AU - Pepsin,P J, AU - Edwards,L, AU - Stanford,R H, AU - Rickard,K, PY - 2000/12/2/pubmed PY - 2001/2/28/medline PY - 2000/12/2/entrez SP - 398 EP - 406 JF - Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology JO - Ann Allergy Asthma Immunol VL - 85 IS - 5 N2 - BACKGROUND: The use of inhaled corticosteroids compared with leukotriene modifying drugs in the treatment of persistent asthma has not been extensively studied. OBJECTIVE: To compare the efficacy and safety of a low dose of fluticasone propionate (FP) and zafirlukast in patients previously maintained on inhaled corticosteroids. METHODS: Patients (> or = 12 years old; FEV1 = 60% to 85% of predicted) with persistent asthma who were previously treated with low doses of triamcinolone acetonide (TAA) 400 to 800 microg/day or beclomethasone dipropionate (BDP) 168 to 336 microg/day were randomized to treatment with FP aerosol 88 microg BID (FP, n = 221) or zafirlukast 20 mg BID (n = 216) over 6 weeks. RESULTS: Treatment with FP significantly increased the mean change at endpoint (the last post-baseline observation) in FEV1 (0.22 L versus 0.03 L, P < .001), morning PEF (17.8 versus 3.1 L/min, P = .004), evening PEF (16.7 versus 2.6 L/min, P = .002), the percentage of symptom-free days (16.2 versus 7.1%, P = .007), and the percentage of rescue-free days (23.4 versus 9.3%, P < .001), and significantly decreased rescue albuterol use (-0.66 puffs/day versus an increase of 0.27 puffs/day, P < .001) and combined symptom scores (-0.13 versus an increase of 0.08, P < .001) compared with zafirlukast. Treatment with FP maintained the percentage of awakening-free nights (-1.0 +/- 1.0); in contrast, treatment with zafirlukast reduced the percentage of awakening-free nights (-9.0 +/- 1.6, P < .001). A clinically meaningful difference (change of > or = 0.5; P < .001) was observed between FP and zafirlukast in the Asthma Quality of Life Questionnaire (AQLQ) global score and for each domain score except activity limitation (change of 0.3, P < .001). Significantly more patients in the zafirlukast group experienced an asthma exacerbation (n = 14) compared with FP-treated patients (n = 5, P = .035). Patients in the zafirlukast group were significantly more likely to be withdrawn due to lack of efficacy (P < .001). CONCLUSION: Switching patients from low doses of inhaled corticosteroids to a lower total microgram dose of FP improves pulmonary function, asthma symptoms, and quality of life, while switching to the leukotriene receptor antagonist zafirlukast may result in worsening of asthma control. This was indicated by the significant number of zafirlukast-treated patients who were dropped from the study due to lack of efficacy within 6 weeks of discontinuing inhaled corticosteroids. SN - 1081-1206 UR - https://www.unboundmedicine.com/medline/citation/11101185/Fluticasone_propionate_versus_zafirlukast:_effect_in_patients_previously_receiving_inhaled_corticosteroid_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1081-1206(10)62555-0 DB - PRIME DP - Unbound Medicine ER -