Fluticasone versus beclomethasone or budesonide for chronic asthma in adults and children.

BACKGROUND Beclomethasone dipropionate (BDP) and budesonide (BUD) are commonly prescribed inhaled corticosteroids for the treatment of asthma. Fluticasone propionate (FP) is newer agent with greater potency in in-vitro assays. OBJECTIVES To compare the efficacy and safety of Fluticasone to Beclomethasone or Budesonide in the treatment of chronic asthma. SEARCH STRATEGY We searched the Cochrane Airways Group trial register (January 2007) and reference lists of articles. We contacted trialists and pharmaceutical companies for additional studies and searched abstracts of major respiratory society meetings (1997 to 2006). SELECTION CRITERIA Randomised trials in children and adults comparing Fluticasone to either Beclomethasone or Budesonide in the treatment of chronic asthma. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed articles for inclusion and methodological quality. One reviewer extracted data. Quantitative analyses were undertaken using RevMan analyses 1.0.1. MAIN RESULTS Seventy-one studies (14,602 participants) representing 74 randomised comparisons met the inclusion criteria. Methodological quality was fair. Dose ratio 1:2: FP produced a significantly greater end of treatment FEV1 (0.04 litres (95% CI 0 to 0.07 litres), end of treatment and change in morning PEF, but not change in FEV1 or evening PEF. This applied to all drug doses, age groups, and delivery devices. No difference between FP and BDP/BUD were seen for trial withdrawals. FP led to fewer symptoms and less rescue medication use. When given at half the dose of BDP/BUD, FP led to a greater likelihood of pharyngitis. There was no difference in the likelihood of oral candidiasis. Plasma cortisol and 24 hour urinary cortisol was measured frequently but data presentation was limited. Dose ratio 1:1: FP produced a statistically significant difference in morning PEF, evening PEF, and FEV1 over BDP or BUD. The effects on exacerbations were mixed. There were no significant differences incidence of hoarseness, pharyngitis, candidiasis, or cough. AUTHORS' CONCLUSIONS Fluticasone given at half the daily dose of beclomethasone or budesonide leads to small improvements in measures of airway calibre, but it appears to have a higher risk of causing sore throat and when given at the same daily dose leads to increased hoarseness. There are concerns about adrenal suppression with Fluticasone given to children at doses greater than 400 mcg/day, but the randomised trials included in this review did not provide sufficient data to address this issue.

[1]  J. Bestall,et al.  Fluticasone at different doses for chronic asthma in adults and children. , 2008, The Cochrane database of systematic reviews.

[2]  B. Ställberg,et al.  Potency ratio fluticasone propionate (Flixotide Diskus)/budesonide (Pulmicort Turbuhaler). , 2007, Respiratory medicine.

[3]  C. Goldfrad,et al.  A comparison of the relative growth velocities with budesonide and fluticasone propionate in children with asthma. , 2007, Respiratory medicine.

[4]  J. Paton,et al.  Adrenal responses to low dose synthetic ACTH (Synacthen) in children receiving high dose inhaled fluticasone , 2006, Archives of Disease in Childhood.

[5]  J. Adams,et al.  Effects on bone mineral density of inhaled corticosteroids (fluticasone propionate and beclomethasone dipropionate: A two year double-blind randomised study , 2006, Osteoporosis International.

[6]  T. Lasserson,et al.  Fluticasone versus HFA-beclomethasone dipropionate for chronic asthma in adults and children. , 2006, The Cochrane database of systematic reviews.

[7]  P. Mahesh,et al.  Quality of life assessment in asthmatic patients receiving fluticasone compared with equipotent doses of beclomethasone or budesonide , 2005 .

[8]  D. Moyse,et al.  Improvement of asthma control with beclomethasone extrafine aerosol compared to fluticasone and budesonide. , 2005, Respiratory medicine.

[9]  B. Ermiş,et al.  Effects of inhaled corticosteroids on growth in asthmatic children: a comparison of fluticasone propionate with budesonide. , 2005, Allergy and asthma proceedings.

[10]  P. Jones,et al.  Inhaled fluticasone versus inhaled beclomethasone or inhaled budesonide for chronic asthma in adults and children. , 2005, The Cochrane database of systematic reviews.

[11]  P. O'Byrne,et al.  Protection by budesonide and fluticasone on allergen-induced airway responses after discontinuation of therapy. , 2005, The Journal of allergy and clinical immunology.

[12]  P. Jones,et al.  Inhaled fluticasone versus inhaled beclomethasone or inhaled budesonide for chronic asthma. , 2004, The Cochrane database of systematic reviews.

[13]  A. Grahnén,et al.  An assessment of the systemic effects of single and repeated doses of inhaled fluticasone propionate and inhaled budesonide in healthy volunteers , 2004, European Journal of Clinical Pharmacology.

[14]  A. Tattersfield,et al.  Time course of action of two inhaled corticosteroids, fluticasone propionate and budesonide , 2003, Thorax.

[15]  S. See,et al.  Tapering inhaled steroids effective for chronic asthma. , 2003, The Journal of family practice.

[16]  P. Gibson,et al.  Improvement in health‐related quality of life with fluticasone propionate compared with budesonide or beclomethasone dipropionate in adults with severe asthma , 2003, Respirology.

[17]  H. Magnussen,et al.  A randomized, double-blind, double-dummy, parallel-group, multicenter, dose-reduction trial of the minimal effective doses of budesonide and fluticasone dry-powder inhalers in adults with mild to moderate asthma. , 2003, Clinical therapeutics.

[18]  N. Thomson,et al.  Stepping down inhaled corticosteroids in asthma: randomised controlled trial , 2003, BMJ : British Medical Journal.

[19]  F. Gleeson,et al.  Introduction to the methods used in the generation of the British Thoracic Society guidelines for the management of pleural diseases , 2003 .

[20]  O. Ige,et al.  The clinical efficacy of fluticasone propionate (Fluvent) compared with beclomethasone dipropionates (Becotide) in patients with mild to moderate brochial asthma at the University College Hospital, Ibadan, Nigeria. , 2004, West African journal of medicine.

[21]  B. Lipworth,et al.  Airway and systemic effects of hydrofluoroalkane fluticasone and beclomethasone in patients with asthma , 2002, Thorax.

[22]  B. Lipworth,et al.  Therapeutic ratio of hydrofluoroalkane and chlorofluorocarbon formulations of fluticasone propionate. , 2002, Chest.

[23]  Stephen C Lazarus,et al.  Banks CORTICOSTEROIDS FOR PERSISTENT ASTHMA SIGNIFICANT VARIABILITY IN RESPONSE TO INHALED Services , 2022 .

[24]  R. Voutilainen,et al.  Efficacy and safety of inhaled steroid and cromone treatment in school‐age children: 
A randomized pragmatic pilot study , 2002, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[25]  P. Jones,et al.  Inhaled fluticasone at different doses for chronic asthma. , 2000, The Cochrane database of systematic reviews.

[26]  B. Lipworth,et al.  Airway-systemic ratio of hydrofluoroalkane fluticasone and beclomethasone in asthmatics , 2002 .

[27]  R. Sharma,et al.  Fluticasone Propionate via Diskus™ Inhaler at Half the Microgram Dose of Budesonide via Turbuhaler™ Inhaler , 2001 .

[28]  A. Boner,et al.  Effects of 2 inhaled corticosteroids on growth: results of a randomized controlled trial. , 2001, Archives of pediatrics & adolescent medicine.

[29]  P. Sly,et al.  Improved safety with equivalent asthma control in adults with chronic severe asthma on high‐dose fluticasone propionate , 2001, Respirology.

[30]  C. -. Huang,et al.  A comparison of clinical use of fluticasone propionate and beclomethasone dipropionate in pediatric asthma. , 2001, The Kaohsiung journal of medical sciences.

[31]  I. Hall,et al.  A randomized, double-blind comparison of beclomethasone dipropionate extrafine aerosol and fluticasone propionate. , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[32]  S. Gans,et al.  Efficacy of HFA-beclomethasone dipropionate extra-fine aerosol (800 μ g day−1) versus HFA-fluticasone propionate (1000 μ g day−1) in patients with asthma , 2001 .

[33]  A. Tattersfield,et al.  Comparison of the systemic effects of fluticasone propionate and budesonide given by dry powder inhaler in healthy and asthmatic subjects , 2001, Thorax.

[34]  A Comparison of the Efficacy and Safety of a Half Dose of Fluticasone Propionate with Beclamethasone Dipropionate and Budesonide in Childhood Asthma , 2001, The Journal of asthma : official journal of the Association for the Care of Asthma.

[35]  M. Metintaş,et al.  Fluticasone propionate and budesonide do not influence bone metabolism in the long term treatment of asthma. , 2001, Allergologia et immunopathologia.

[36]  R. Dahl,et al.  Therapeutic ratio of inhaled corticosteroids in adult asthma. A dose-range comparison between fluticasone propionate and budesonide, measuring their effect on bronchial hyperresponsiveness and adrenal cortex function. , 2000, American journal of respiratory and critical care medicine.

[37]  A. Rooklin,et al.  Comparison of once- and twice-daily dosing of fluticasone propionate 200 micrograms per day administered by diskus device in patients with asthma treated with or without inhaled corticosteroids. , 2000, The Journal of allergy and clinical immunology.

[38]  B. Lundbäck,et al.  Comparable effects of inhaled fluticasone propionate and budesonide on the HPA-axis in adult asthmatic patients. , 2000, Respiratory medicine.

[39]  P. Rüegsegger,et al.  Effect of one year treatment with inhaled fluticasone propionate or beclomethasone dipropionate on bone density and bone metabolism: a randomised parallel group study in adult asthmatic subjects , 2000, Thorax.

[40]  R. Voutilainen,et al.  Adrenal suppression, evaluated by a low dose adrenocorticotropin test, and growth in asthmatic children treated with inhaled steroids. , 2000, The Journal of clinical endocrinology and metabolism.

[41]  Joon Chang,et al.  Fluticasone Propionate and Beclomethasone Dipropionate in Asthmatic Patients , 1999 .

[42]  J. Bestall,et al.  Beclomethasone at different doses for chronic asthma , 1999 .

[43]  L. Boulet,et al.  The effect of high-dose fluticasone propionate and budesonide on lung function and asthma exacerbations in patients with severe asthma. , 1999, Respiratory medicine.

[44]  R. Schleimer,et al.  An in vitro comparison of commonly used topical glucocorticoid preparations. , 1999, The Journal of allergy and clinical immunology.

[45]  R. Pauwels,et al.  Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma. , 1999, American journal of respiratory and critical care medicine.

[46]  A. Woodcock,et al.  A randomized, double-blind study comparing the effects of beclomethasone and fluticasone on bone density over two years. , 1999, The European respiratory journal.

[47]  N. Barnes,et al.  The cost-effectiveness of inhaled fluticasone propionate and budesonide in the treatment of asthma in adults and children. , 1999, Respiratory medicine.

[48]  B. Lipworth.  Systemic adverse effects of inhaled corticosteroid therapy: A systematic review and meta-analysis. , 1999, Archives of internal medicine.

[49]  L. Edwards,et al.  A comparison of multiple doses of fluticasone propionate and beclomethasone dipropionate in subjects with persistent asthma. , 1999, The Journal of allergy and clinical immunology.

[50]  L. Boulet,et al.  Skin bruising, adrenal function and markers of bone metabolism in asthmatics using inhaled beclomethasone and fluticasone. , 1999, The European respiratory journal.

[51]  F. Versteegh,et al.  Efficacy and safety of high-dose inhaled steroids in children with asthma: a comparison of fluticasone propionate with budesonide. , 1999, The Journal of pediatrics.

[52]  R. Eastell,et al.  One year prospective open study of the effect of high dose inhaled steroids, fluticasone propionate, and budesonide on bone markers and bone mineral density , 1999, Thorax.

[53]  J. Warner,et al.  Systemic effects of inhaled corticosteroids on growth and bone turnover in childhood asthma: a comparison of fluticasone with beclomethasone. , 1999, The European respiratory journal.

[54]  H. Kelly.  Establishing a therapeutic index for the inhaled corticosteroids: part I. Pharmacokinetic/pharmacodynamic comparison of the inhaled corticosteroids. , 1998, The Journal of allergy and clinical immunology.

[55]  P. V. van Asperen,et al.  Fluticasone propionate 750 μg/day versus beclomethasone dipropionate 1500 μg/day: comparison of efficacy and adrenal function in paediatric asthma , 1998 .

[56]  J. Lammers,et al.  Effects of fluticasone propionate and beclomethasone dipropionate on parameters of inflammation in peripheral blood of patients with asthma , 1998, Allergy.

[57]  C. Mackenzie,et al.  Effects of inhaled corticosteroids on growth. , 1998, The Journal of allergy and clinical immunology.

[58]  P. Geusens,et al.  Safety and Efficacy of Fluticasone and Beclomethasone in Moderate to Severe Asthma , 1998 .

[59]  D. Price,et al.  Fluticasone propionate: an audit of outcomes and cost-effectiveness in primary care. , 1998, Respiratory medicine.

[60]  D. Weir,et al.  Is high-dose fluticasone propionate via a metered-dose inhaler and Volumatic as efficacious as nebulized budesonide in adult asthmatics? , 1998, Respiratory medicine.

[61]  T. Harris,et al.  Clinical experience with fluticasone propionate in asthma: a meta-analysis of efficacy and systemic activity compared with budesonide and beclomethasone dipropionate at half the microgram dose or less. , 1998, Respiratory medicine.

[62]  T. Volmer,et al.  Cost Effectiveness of Fluticasone and Budesonide in Patients with Moderate Asthma , 1998, Clinical drug investigation.

[63]  B. Lipworth,et al.  Adrenocortical activity with repeated administration of one-daily inhaled fluticasone propionate and budesonide in asthmatic adults , 1998, European Journal of Clinical Pharmacology.

[64]  J. Warner,et al.  Effect of Inhaled Corticosteroids on Bone Mineral Density in Childhood Asthma: Comparison of Fluticasone Propionate with Beclomethasone Dipropionate , 1998, Osteoporosis International.

[65]  J. Paulson,et al.  Pharmacokinetics and systemic effects of inhaled fluticasone propionate in healthy subjects. , 2003, British journal of clinical pharmacology.

[66]  B. Lipworth,et al.  Adrenocortical activity with repeated twice daily dosing of fluticasone propionate and budesonide given via a large volume spacer to asthmatic school children. , 1997, Thorax.

[67]  S. Pedersen,et al.  Short-term knemometry and urine cortisol excretion in children treated with fluticasone propionate and budesonide: a dose response study. , 1997, The European respiratory journal.

[68]  S. Pedersen,et al.  A randomized, double-blind dose reduction study to compare the minimal effective dose of budesonide Turbuhaler and fluticasone propionate Diskhaler. , 1997, The Journal of allergy and clinical immunology.

[69]  A. Milner,et al.  Adrenal function and high dose inhaled corticosteroids for asthma , 1997, Archives of disease in childhood.

[70]  K. Richards,et al.  EASE OF HANDLING AND CLINICAL EFFICACY OF FLUTICASONE PROPIONATE ACCUHALER/DISKUS™ INHALER COMPARED WITH THE TURBOHALER™ INHALER IN PAEDIATRIC PATIENTS , 1997, The British journal of clinical practice.

[71]  B. Lipworth,et al.  Adrenal suppression with chronic dosing of fluticasone propionate compared with budesonide in adult asthmatic patients. , 1997, Thorax.

[72]  A. Juul,et al.  Knemometry, Urine Cortisol Excretion, and Measures of the Insulin-Like Growth Factor Axis and Collagen Turnover in Children Treated with Inhaled Glucocorticosteroids , 1997, Pediatric Research.

[73]  R. Sorva,et al.  Fluticasone propionate compared with budesonide: a double-blind trial in asthmatic children using powder devices at a dosage of 400 microg x day(-1). , 1996, The European respiratory journal.

[74]  F. Bonifazi,et al.  Fluticasone propionate 1 mg daily and beclomethasone dipropionate 2 mg daily: a comparison over 1 yr. , 1996, Respiratory medicine.

[75]  P. Swinburn,et al.  A blinded comparison of fluticasone propionate with budesonide via powder devices in adult patients with moderate-to-severe asthma: a clinical evaluation , 1996, Mediators of inflammation.

[76]  B. Lipworth,et al.  Adrenal suppression with inhaled budesonide and fluticasone propionate given by large volume spacer to asthmatic children. , 1996, Thorax.

[77]  G. Bootsma,et al.  Fluticasone propionate does not influence bone metabolism in contrast to beclomethasone dipropionate. , 1996, American journal of respiratory and critical care medicine.

[78]  B. Lipworth,et al.  Comparative adrenal suppression with inhaled budesonide and fluticasone propionate in adult asthmatic patients. , 1996, Thorax.

[79]  A R Jadad,et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary? , 1996, Controlled clinical trials.

[80]  C. Pickering,et al.  267 A comparison of fluticasone propionate via Diskus™(Accuhaler™) inhaler and budesonide via Turbuhaler™ inhaler in adult asthmatics , 1996 .

[81]  G. Bootsma,et al.  Comparison of fluticasone propionate and beclomethasone dipropionate on direct and indirect measurements of bronchial hyperresponsiveness in patients with stable asthma. , 1995, Thorax.

[82]  E. Bateman,et al.  High dose fluticasone propionate, 1 mg daily, versus fluticasone propionate, 2 mg daily, or budesonide, 1.6 mg daily, in patients with chronic severe asthma. International Study Group. , 1995, The European respiratory journal.

[83]  N. Hanania,et al.  Adverse effects of inhaled corticosteroids. , 1995, The American journal of medicine.

[84]  A. Gulsvik,et al.  High-dose inhaled steroids in asthmatics: moderate efficacy gain and suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Research Council of the Norwegian Thoracic Society. , 1994, The European respiratory journal.

[85]  P. Leblanc,et al.  A comparison of fluticasone propionate 200 μg/day with beclomethasone dipropionate 400 μg/day in adult asthma , 1994, Allergy.

[86]  J. Hébert,et al.  Evaluation of fluticasone propionate (500 μg day−1) administered either as dry powder via a Diskhaler® inhaler or pressurized inhaler and compared with beclomethasone dipropionate (1000 μg day−1) administered by pressurized inhaler , 1993 .

[87]  R. Dahl,et al.  A Dose-Ranging Study of Fluticasone Propionate in Adult Patients With Moderate Asthma , 1993 .

[88]  M. Gold,et al.  Comparison of the efficacy and safety of inhaled fluticasone propionate 200 micrograms/day with inhaled beclomethasone dipropionate 400 micrograms/day in mild and moderate asthma. , 1993, Archives of disease in childhood.

[89]  L. Fabbri,et al.  Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year. International Study Group. , 1993, Thorax.

[90]  G. Marone,et al.  A comparison of fluticasone propionate, 1 mg daily, with beclomethasone dipropionate, 2 mg daily, in the treatment of severe asthma. International Study Group. , 1993, The European respiratory journal.

[91]  S. Pedersen,et al.  Short-term growth during treatment with inhaled fluticasone propionate and beclomethasone dipropionate. , 1993, Archives of disease in childhood.

[92]  G. H. Phillipps.  Structure-activity relationships of topically active steroids: the selection of fluticasone propionate. , 1990, Respiratory medicine.