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LONDON (Reuters Health) – In adolescents and adults with asthma, most of the beneficial effects of inhaled fluticasone are achieved at a daily dose of 100 to 250 µg, with a maximum effect achieved at a dose of about 500 µg/day, according to a report published in the August 4th online edition of the British Medical Journal.
Dr. Richard Beasley and colleagues, from the Wellington School of Medicine in New Zealand, assessed the dose-response relationship of inhaled fluticasone by performing a meta-analysis of eight placebo-controlled, randomised clinical trials. The studies included a total of 2324 adolescents and adults with asthma.
The dose-response curve reached a plateau at about 100 to 200 µg/day and peaked by 500 µg/day, the authors determined. Negative exponential modelling, without meta-analysis, revealed that most of the benefit of 1000 µg/day therapy was achieved at much lower doses.
The maximum achievable efficacy was obtained with doses of about 500 µg/day. The investigators point out, however, that there were few studies that examined the dose-response relationship above 500 µg/day.
"Despite the limitation of the lack of data for doses of >500 µg/day, national and international guidelines and formularies need to be modified so that they are consistent with the published data from which this therapeutic dose-response relation has been derived," the investigators suggest.
"This study partially explains why adding a long-acting beta-agonist is more efficacious than increasing the dose of fluticasone beyond a dose of 200 to 500 µg/day (or equivalent for other inhaled corticosteroids)," they point out.
Dr. Beasley's team believes that "prescribing inhaled corticosteroids for asthma within this therapeutic dose range…will provide benefits in terms of efficacy, side effects, and cost."
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