SciCombinator

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Concept: Fluticasone/salmeterol

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Background Long-acting beta-agonists (LABAs) have been shown to increase the risk of asthma-related death among adults and the risk of asthma-related hospitalization among children. It is unknown whether the concomitant use of inhaled glucocorticoids with LABAs mitigates those risks. This trial prospectively evaluated the safety of the LABA salmeterol, added to fluticasone propionate, in a fixed-dose combination in children. Methods We randomly assigned, in a 1:1 ratio, children 4 to 11 years of age who required daily asthma medications and had a history of asthma exacerbations in the previous year to receive fluticasone propionate plus salmeterol or fluticasone alone for 26 weeks. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization), as assessed in a time-to-event analysis. The statistical design specified that noninferiority would be shown if the upper boundary of the 95% confidence interval of the hazard ratio for the primary safety end point was less than 2.675. The main efficacy end point was the first severe asthma exacerbation that led to treatment with systemic glucocorticoids, as assessed in a time-to-event analysis. Results Among the 6208 patients, 27 patients in the fluticasone-salmeterol group and 21 in the fluticasone-alone group had a serious asthma-related event (all were hospitalizations); the hazard ratio with fluticasone-salmeterol versus fluticasone alone was 1.28 (95% confidence interval [CI], 0.73 to 2.27), which showed the noninferiority of fluticasone-salmeterol (P=0.006). A total of 265 patients (8.5%) in the fluticasone-salmeterol group and 309 (10.0%) in the fluticasone-alone group had a severe asthma exacerbation (hazard ratio, 0.86; 95% CI, 0.73 to 1.01). Conclusions In this trial involving children with asthma, salmeterol in a fixed-dose combination with fluticasone was associated with the risk of a serious asthma-related event that was similar to the risk with fluticasone alone. (Funded by GlaxoSmithKline; VESTRI ClinicalTrials.gov number, NCT01462344 .).

Concepts: Asthma, Hospital, Risk, Corticosteroid, Glucocorticoid, Long acting beta-adrenoceptor agonist, Fluticasone, Fluticasone/salmeterol

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Asthma is an increasing pathology with poor compliance. Achievement of control is possible but under intensive treatment. In this setting, fluticasone/salmeterol association delivered by dry powder inhalers is a valuable and proved option. A prospective, parallel, open-label, phase IV, multicentre non-inferiority study was conducted to determine therapeutic similarity between 2 different inhalers: Generic DPI and Diskus®, which both deliver a fluticasone/salmeterol association (CAS 80474-14-2/CAS 89365-50-4). A 103 uncontrolled asthmatic patients were randomly assigned in 2 groups, Generic (G) and Diskus® (D), and received the association for 18 weeks through the appropriate device. They were evaluated according to Asthma Quality of Life Questionnaire and GINA/NIH guidelines. To demonstrate non-inferiority, the estimation of the Relative Risk between the Global Score Rate per group with its 95% confidence interval was calculated and compared against a non-inferiority margin obtained from a previous study. The Global Score Rate was 82% for G Group and 83% for D Group. The RR was 1.0124 (95% CI: 0.847-1.210). The margin set at 0.832 was not reached by the lower 95% CI (z=-2.097; p=0.018) pointing out non-inferiority. The results have demonstrated non-inferiority between groups. Thus, the 2 products are therapeutically similar.

Concepts: Asthma, Relative risk, Dry powder inhaler, Inhaler, Nebulizer, Phase IV, Salmeterol, Fluticasone/salmeterol

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The potential of the force control agent (FCA) magnesium stearate (MgSt) to enhance the aerosol performance of lactose-based dry powder inhaled (DPI) formulations was investigated in this study. The excipient blends were investigated with analytical techniques including time-of-flight secondary ion mass spectrometry (ToF-SIMS) and Single Particle Aerosol Mass Spectrometry (SPAMS) and particle size, morphology and surface properties were evaluated. Excipient-blends were manufactured either by high-shear or low-shear blending lactose carrier with different amounts of MgSt in the range from 0-10% (w/w). Fluticasone propionate (FP) and salmeterol xinafoate (SX) used as model APIs were added by low-shear mixing. The in vitro aerosol performance in terms of aerodynamic particle size distribution (APSD) and fine particle fraction (FPF) of the FP and SX DPI formulations was evaluated with the Next Generation Impactor (NGI) and also with SPAMS using a Breezhaler® inhalation device. The distribution of MgSt on the lactose carrier in the blends was visualized and found to depend strongly on the blending method. This affected drug particle detachment from the carrier and thus impacted aerosol performance for FP and SX. Compared to blends without FCA, low-shear blending of MgSt increases the FPF of the model drug SX, while high shear blending significantly increased FPF of both SX and FP. The interactions between drug and carrier particles were substantially affected by the choice of blending technique of MgSt with lactose. This allows detailed control of aerosol performance of a DPI by an adequate choice of the blending technique. SPAMS successfully demonstrated that it is capable to distinguish changes in DPI formulations blended with different amounts of MgSt and additional information in terms of dispersibility of fine particles could be generated.

Concepts: Asthma, Mass spectrometry, Particle size distribution, Particulate, Particulates, Global dimming, Salmeterol, Fluticasone/salmeterol

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Easyhaler®dry powder inhaler (DPI) containing salmeterol and fluticasone propionate was developed for the treatment of asthma and chronic obstructive pulmonary disease. Three different Salmeterol/fluticasone Easyhaler test products (Orion Pharma, Finland) were compared against the reference product Seretide®Diskus®DPI (GlaxoSmithKline, United Kingdom) to study whether any of the test products are bioequivalent with the reference.

Concepts: Medicine, Pulmonology, Asthma, United Kingdom, Chronic obstructive pulmonary disease, GlaxoSmithKline, Fluticasone, Fluticasone/salmeterol

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The study was designed to compare the efficacy and tolerability of a fixed combination of extra-fine beclomethasone and formoterol, with the fixed combination fluticasone and salmeterol in Taiwanese asthmatic patients.

Concepts: Asthma, Chronic obstructive pulmonary disease, Formoterol, Salbutamol, Salmeterol, Fluticasone/salmeterol

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Particle co-associations between the active pharmaceutical ingredients fluticasone propionate and salmeterol xinafoate were examined in dry powder inhaled (DPI) and metered dose inhaled (MDI) combination products. Single Particle Aerosol Mass Spectrometry was used to investigate the particle interactions in Advair Diskus(®) (500/50 mcg) and Seretide(®) (125/25 mcg). A simple rules tree was used to identify each compound, either alone or co-associated at the level of the individual particle, using unique marker peaks in the mass spectra for the identification of each drug. High levels of drug particle co-association (fluticasone-salmeterol) were observed in the aerosols emitted from Advair Diskus(®) and Seretide(®). The majority of the detected salmeterol particles were found to be in co-association with fluticasone in both tested devices. Another significant finding was that rather coarse fluticasone particles (in DPI) and fine salmeterol particles (both MDI and DPI) were forming the particle co-associations.

Concepts: Pharmacology, Asthma, Mass spectrometry, Pharmaceutical drug, Fluticasone propionate, Salmeterol, GlaxoSmithKline, Fluticasone/salmeterol

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The aim of this study was to develop a novel fluticasone propionate (FP) and salmeterol xinafoate (SX)-loaded dry powder inhaler (DPI) system, which was composed of powder formulation and performance. The air flow resistances were determined with various types of DPI device, showing that the modified RS01 device gave the specific resistance similar to the commercial DPI device. The particle properties of fluticasone propionate (FP), salmeterol xinafoate (SX) and inhalation grade lactose particles, such as particle size, size distribution and fine content, were assessed. Subsequently, the aerodynamic behaviours of the DPI powder formulations were evaluated by the in vitro deposition of drugs in the DPI products using Andersen cascade impactor (ACI). Amongst the DPI powder formulations tested, the formulation composed of FP, SX, Respitose® SV003, Respitose(®) SV010 and Respitose(®) ML006 at the weight ratio of 0.5/0.145/19/19/2 gave depositions, emitted dose, fine particle dose, fine particle fraction and mass median aerodynamic diameter of drugs similar to the commercial product, suggesting that they had similar aerodynamic behaviours. Furthermore, it gave excellent content uniformity. Thus, this DPI using the modified RS01 device would be recommended as a candidate for FP and SX-loaded pharmaceutical dry powder inhaler products.

Concepts: Pharmacology, Asthma, Particle physics, Part, Electrical resistance, Dosage forms, Salmeterol, Fluticasone/salmeterol

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To analyse the efficacy of fluticasone propionate (FP) alone and combined with salmeterol (SAL) in achieving guideline-defined asthma control in Asian patients.

Concepts: Asthma, Fluticasone propionate, Post-hoc analysis, Fluticasone, Fluticasone/salmeterol, Fluticasone furoate

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In developing countries, there is a need for access to affordable inhaled respiratory medicines. This study tested the clinical non-inferiority of fluticasone propionate/salmeterol combination (FSC) 50/250 μg Rotacaps(®)/Rotahaler(®) compared with FSC 50/250 μg Diskus(®).

Concepts: Pulmonology, Asthma, Corticosteroid, Respiratory system, Inhalation, Developing country, Fluticasone, Fluticasone/salmeterol