Stepping-across controlled asthmatic patients to extrafine beclometasone/formoterol combination

Clinical and cost effectiveness of switching asthma patients from fluticasone-salmeterol to extra-fine particle beclometasone-formoterol: a retrospective matched observational study of real-world patients

“…The clinical effectiveness of efBDP-FOR in asthma patients requiring combination ICS-LABA therapy is well established. 12–16,21–27,46,47 However, to our knowledge, no studies have evaluated both the clinical and cost effectiveness of switching from another ICS-LABA combination to efBDP-FOR in the typical asthma patient — a scenario that is likely to be increasingly common in primary care, given the substantially lower cost and comparable effectiveness of the efBDP-FOR inhaler and, in the UK, certain NHS recommendations to physicians. 2…”

“…14 In another recent RCT, asthma patients previously controlled with FP-SAL (500μg/day FP) were effectively stepped across or switched to efBDP-FOR (400μg/day efBDP); lung function and asthma control were maintained, no safety issues were reported, and efBDP-FOR was noted to have a relatively rapid (5 min) onset of action. 25 However, those studies involved carefully selected patient populations, as is typical of a RCT, and did not include cost analyses.…”

“…In various studies, efBDP-FOR was at least as effective at improving lung function and measures of asthma control while preventing acute asthma exacerbations as (1) larger particle BDP with FOR delivered via separate inhalers; 23 (2) FP-SAL; 12–16,24,25 and (3) budesonide with formoterol (BUD-FOR). 16,24,26,27 As further evidence, in studies of ICS alone, efBDP was at least as effective for asthma control as larger particle formulations of BDP 28–30 and fluticasone.…”

“…However, despite the reasonable assumption of greater cost effectiveness with the efBDP-FOR inhaler, to date no studies have investigated the outcome of such a switch under real-world conditions of use. The clinical efficacy of switching from FP-SAL to efBDP-FOR, with 14 or without 25 a step-down in ICS dosage, has been shown in two recent RCTs, but it has yet to be demonstrated under less controlled conditions.…”

Once-daily fluticasone furoate/vilanterol versus twice-daily fluticasone propionate/salmeterol in patients with asthma well controlled on ICS/LABA

“…Few studies have evaluated whether asthma control can be maintained when patients are stepped across from one ICS/LABA to another (18,19); therefore, this Phase IIIa study was conducted to evaluate whether FF/VI 100/25 µg OD was non-inferior to FP/SAL 250/50 µg BID in adult and adolescent patients with persistent asthma already well controlled on BID ICS/LABA. The study examined lung function and tolerability, as well as patientreported symptoms and quality of life.…”