Mometasone/indacaterol inhaler bests fluticasone/salmeterol combo in difficult asthma: BMJ

Asthma is a prevalent chronic disease of the respiratory system and needs immediate care. Despite higher standard of care inhaled corticosteroid (ICS) or long-acting β2-agonist therapies, a substantial proportion of patients with asthma remain inadequately controlled.

A new study by Dr Kenneth Chapman and team revealed that high-dose mometasone furoate/indacaterol acetate (MF/IND) when used once a day reduced asthma exacerbations and improved lung function than fluticasone propionate/salmeterol xinafoate (FLU/SAL) that was used two times a day, in patients with inadequately controlled asthma.

The study demonstrates the superiority of a once-daily high-dose ICS-LABA formulation such as MF/IND as compared with twice-daily ICS-LABA as a potential treatment for asthma.

The study has been published in the journal BMJ Open Respiratory Research.

The objective of the study was to evaluate efficacy and safety of MF/IND versus FLU/SAL in patients with inadequately controlled asthma.

The study was an analysis including patients from palladium and iridium studies who received high-dose MF/IND (320/150 µg) or medium-dose MF/IND (160/150 µg) one time a day or high-dose FLU/SAL (500/50 µg) two times a day for 52 weeks. Reduction in asthma exacerbations, improvement in lung function, asthma control, and safety were evaluated for 52 weeks.

The results of the study were

• A total of, 3154 patients (high-dose MF/IND, n=1054; medium-dose MF/IND, n=1044; high-dose FLU/SAL, n=1056) were included.

• High-dose MF/IND showed 26%, 22% and 19% reductions in rate of severe, moderate or severe, and all (mild, moderate and severe) exacerbations versus high-dose FLU/SAL, respectively, over 52 weeks (all, p<0.05).

• High-dose MF/IND improved trough FEV1 versus high-dose FLU/SAL at weeks 26 (Δ, 43 mL, p=0.001) and 52 (Δ, 51 mL, p<0.001).

• Reductions in asthma exacerbation rate and improvement in trough FEV1 with medium-dose MF/IND were comparable with high-dose FLU/SAL over 52 weeks.

• All treatments improved Asthma Control Questionnaire-7 score from baseline to 52 weeks with no difference between treatments. Safety was comparable between high-dose MF/IND and high-dose FLU/SAL.

Dr Chapman and team concluded that when high-dose MF/IND used one time a day, single-inhaler, reduced asthma exacerbations and improved lung function compared to two times a day, high-dose FLU/SAL in patients with inadequately controlled asthma. Similarly, improved outcomes were seen with one time a day, medium-dose MF/IND and two times a day, high-dose FLU/SAL, but at a lower ICS dose.

Reference: 

http://dx.doi.org/10.1136/bmjresp-2020-000819