Evaluation of switching low-dose inhaled corticosteroid to pranlukast for step-down therapy in well-controlled patients with mild persistent asthma

Harada, Sonoko; Harada, Norihiro; Itoigawa, Yukinari; Katsura, Yoko; Kasuga, Fumiko; Ishimori, A; Makino, Fumihiko; Ito, Jun; Atsuta, Ryo; Takahashi, Kazuhisa

doi:10.3109/02770903.2015.1087556

Cited by 10 publications

(23 citation statements)

References 42 publications

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“…(23)(24)(25)(26)(27)(28)(29)(30) The authors of four studies provided individual patient data (IPD) for all participants who met our eligibility criteria. (24,27,28,30) The authors of one study (29) were unable to provide IPD from participants recruited at one recruitment centre due to internal reasons, but provided IPD for all other participants. Data from a further two studies (25,26) were obtained from the National Heart, Lung, and Blood Institute (NHLBI) BioLINCC repository (Biologic Specimen and Data Repository Information Coordinating Center, https://biolincc.nhlbi.nih.gov/home/).…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…Three studies were conducted in hospital outpatient clinics, (24,28,29) one in primary care,(30) one in university-based ambulatory care centres, (25) and one in clinical centres in the US. (27) One study recruited patients from communities surrounding testing and referral centres in an Asthma Clinical Research Network.…”

Section: Overview Of Studies Which Provided Ipdmentioning

confidence: 99%

“…Four studies included participants whose asthma had been well controlled for at least three months. (24,(28)(29)(30) Three RCTs included participants whose asthma had been well controlled for six weeks (25,26) or four weeks (27) and included some participants who had not previously used controller treatment before the initial ICS treatment phase.…”

Section: Overview Of Studies Which Provided Ipdmentioning

confidence: 99%

“…Two studies defined well controlled asthma based on GINA criteria, (28,29) one based on US National Asthma Education and Prevention Program asthma care guidelines, (27) and three according to clinical criteria including FEV1 >80% of predicted value and average peak flow variability <=20% during the final two weeks of the ICS treatment period,(25) Asthma Control Test (ACT) score of >19, (24) and Asthma Control Questionnaire 5-item version score of <=1.5 and absence of exacerbations requiring oral corticosteroids. (30) One study did not provide an explicit definition of well controlled asthma (26) but did state that participants who experienced a significant asthma exacerbation during the initial 6-week ICS treatment phase were withdrawn before randomisation.…”

Section: Overview Of Studies Which Provided Ipdmentioning

confidence: 99%

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Prognostic value of using FeNO to guide step-down treatment decisions in asthma

Verbakel

Fleming-Nouri

Brewin

et al. 2018

Monitoring Airway Disease

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Introduction Use of fractional exhaled nitric oxide (FeNO) is recommended for asthma diagnosis but its role in guiding safe reduction of inhaled corticosteroids (ICS) is unclear. Aims and objectives To assess the value of FeNO in identifying asthma patients in whom ICS can be safely reduced. Methods We performed a systematic electronic database search to identify studies which recruited asthma patients aged >=12 years maintained on low to moderate dose ICS in whom FeNO was measured at baseline before subsequently stepping down ICS treatment, irrespective of what the baseline FeNO value was. We performed multi-level mixed-effects logistic regression in relation to absence or presence of acute exacerbations up to 12 weeks after stepping down ICS, accounting for withinstudy clustering, age, sex and FeNO as baseline covariates. FeNO was categorised as low (<=20 ppb [parts per billion]), intermediate (>20 ppb to <50 ppb) or high (>=50 ppb). Net benefit values were calculated for ICS step-down guided by FeNO versus stepping down ICS in all patients or no patients for baseline exacerbation risk thresholds up to 30%. Results We obtained individual patient data from seven studies (393 patients; acute exacerbation, n=44). After adjustment for all baseline covariates in our regression model, exacerbation risk was significantly higher in patients with high FeNO (odds ratio [OR] 2.70, 95% confidence interval 1.16 to 6.26, p=0.021) than low FeNO. FeNO-guided step-down decisions had greater net benefit than stepping down treatment in all patients or no patients at baseline exacerbation risk thresholds between 6% and 16%. Conclusion Patients with mild-to-moderate asthma whose FeNO is >=50 ppb are at greater risk of exacerbation following ICS reduction than patients whose FeNO is in the low or intermediate range. Assessment of FeNO is therefore important in guiding safe clinical decisions about stepping down treatment in asthma patients who appear to be symptomatically controlled on low or moderate dose ICS.

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Section: Data Synthesis and Analysismentioning

confidence: 99%

Section: Overview Of Studies Which Provided Ipdmentioning

confidence: 99%

Section: Overview Of Studies Which Provided Ipdmentioning

confidence: 99%

Section: Overview Of Studies Which Provided Ipdmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic value of using FeNO to guide step-down treatment decisions in asthma

Verbakel

Fleming-Nouri

Brewin

et al. 2018

Monitoring Airway Disease

View full text Add to dashboard Cite

show abstract

“…70 A subsequent RCT of 40 patients found similar results with substitution of inhaled corticosteroid with pranlukast (72% controlled in pranlukast group compared with 90% controlled in inhaled corticosteroid group). 71 One observational study suggests that sputum eosinophil counts may help to guide step-down with LTRA. 72 73 Therefore, although substitution of inhaled corticosteroid for LTRAs seems to increase the risk of exacerbation, the use of biomarkers may help to target step-down to those patients who are most likely to be successful, as may the use of a predictive model using multiple variables.…”

Section: Substitution Of Leukotriene Receptor Antagonists For Inhaledmentioning

confidence: 99%

Why and how to step down chronic asthma drugs

Gionfriddo

Hagan

Rank

2017

BMJ

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Asthma is a common chronic airways disease. The goal of asthma management is to control symptoms while minimizing the side effects of treatment. Following a period of stable asthma, clinicians should consider stepping down treatment. This approach is recommended by current guidelines. Step-down has been studied for several types of asthma drug regimens, and certain approaches may have lower risk than others. Systematic reviews of multiple trials support the following specific step-down approaches: optimizing inhaled corticosteroid dosing when stepping down oral corticosteroid, reducing inhaled corticosteroid from a higher dose, lowering inhaled corticosteroid-long acting bronchodilator (ICS-LABA) dose while adding ICS-LABA on-demand, adding leukotriene receptor antagonist (LTRA) while lowering inhaled corticosteroid dose, and using allergen immunotherapy when reducing inhaled corticosteroid from a higher dose. Systematic reviews of multiple trials support an increased risk of asthma exacerbation for patients who completely stop taking inhaled corticosteroid or long acting bronchodilator. Strategies to implement step-down in practice include the use of risk prediction as well as tools to support shared decision making and communication about risk between clinicians and patients.

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Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma

Chauhan

Jeyaraman

Mann

et al. 2017

Cochrane Database of Systematic Reviews

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Analysis 3.12. Comparison 3 Anti-leukotrienes and inhaled corticosteroids versus TAPERING dose of inhaled corticosteroids, Outcome 12 Change from baseline in mean night-time asthma symptom score.. .. .. Analysis 3.13. Comparison 3 Anti-leukotrienes and inhaled corticosteroids versus TAPERING dose of inhaled corticosteroids, Outcome 13 Change from baseline in mean daily use of β2-agonists (puffs/d).. .. .. . Analysis 3.14. Comparison 3 Anti-leukotrienes and inhaled corticosteroids versus TAPERING dose of inhaled corticosteroids, Outcome 14

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Evaluation of switching low-dose inhaled corticosteroid to pranlukast for step-down therapy in well-controlled patients with mild persistent asthma

Cited by 10 publications

References 42 publications

Prognostic value of using FeNO to guide step-down treatment decisions in asthma

Prognostic value of using FeNO to guide step-down treatment decisions in asthma

Why and how to step down chronic asthma drugs

Addition of anti-leukotriene agents to inhaled corticosteroids for adults and adolescents with persistent asthma

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