Therapy Analysis - Asthma
Fixed-dose combinations
The current treatment of choice for asthmatics not managed on low-to-moderate doses of inhaled steroid is fixed combinational inhalers of LABAs and corticosteroids. This developed from numerous studies that showed a LABA in combination with a corticosteroid gave greater clinical improvements than increasing corticosteroid dose alone. Recent evidence has shown that LABA enhances GR translocation in the presence of corticosteroids, which is believed to be decreased in steroid-insensitive asthma. Several pharmaceutical companies have developed fixed-dose combinations of a LABA and a corticosteroid, and subsequently manipulated delivery technologies to provide greater therapeutic indexes and reduced steroid-related adverse events.
Currently, 3 different formulations containing combinations have been launched. Seretide, a combination of salmeterol + fluticasone, is launched in over 100 countries, with its first launch being in Sweden in 1998. In several Phase III trials, Seretide maintained asthma stability at a 60% dose reduction vs inhaled corticosteroid monotherapy. Furthermore, it significantly improved peak respiratory flow and gave more symptom-free and rescue-free days compared with with salmeterol or fluticasone alone.
Symbicort, launched in the EU in 2000, is a combinational inhaler of budesonide and the LABA formoterol, developed by AstraZeneca. It is the only inhaled steroid-bronchodilator combination that allows patients to adjust their dose to control their symptoms. It is approved in almost 80 countries worldwide and launched as a pressurized metered-dose inhaler in the US. Additionally, it was the first inhaler to receive approval in difficult-to-manage COPD.
