Budesonide/Formoterol Adjustable Maintenance Dosing Reduces Asthma Exacerbations Versus Fixed Dosing

Abstract

SUMMARYA guided, adjustable‐dosing regimen with budesonide/formoterol was investigated in asthma patients. In a randomised, open, multicentre study, 1034 patients received budesonide/formoterol (Symbicort®, Turbuhaler®,) 80/4.5 μg or 160/4.5 μg (depending on pre‐study inhaled corticosteroid dose) two inhalations twice daily for four weeks, followed by adjustable or fixed maintenance dosing for six months. Patients receiving adjustable dosing stepped down to one inhalation twice daily if symptoms were controlled and could, if symptoms worsened, step up to four inhalations twice daily for one or two weeks according to a self‐guided management plan. The primary efficacy variable was occurrence of exacerbations. Compared with fixed dosing, adjustable dosing was associated with fewer patients experiencing exacerbations (6.2% vs 9.5%, NNT 30, p<0.05), fewer daily inhalations of budesonide/formoterol (2.35 vs 3.95, p<0.001), lower costs (six‐month saving €98, p<0.001) and was similarly well tolerated. Adjustable maintenance dosing with budesonide/formoterol provides more effective asthma control than fixed dosing, and reduces costs.

Differences in the effectiveness of single, dual, and triple inhaled corticosteroid therapy for reducing future risk of severe asthma exacerbation: A systematic review and network meta-analysis

“…1 ). Through this process, 43 studies [ [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] ] with 63,097 patients and 25 studies [ 12 , 62 , [69] , [70] , [71] , [74] , [75] , [76] , [77] , [78] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] ...…”

“…When five studies [ 39 , [42] , [43] , [44] , 47 ] were excluded due to the small numbers of eligible patients for re-analyzing the direct comparison between non-ICS and single ICS by means of pairwise meta-analysis, heterogeneity became low grade (I 2 41 %). NMA was conducted using 38 studies [ 40 , 41 , 45 , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] ] with 62,176 patients to analyze the RR for severe asthma exacerbations. However, because the pairwise meta-analysis for ARR was not guaranteed to be homogenous, we did not conduct an NMA.…”