Once-daily fluticasone furoate is efficacious in patients with symptomatic asthma on low-dose inhaled corticosteroids

Background: Fluticasone furoate (FF) is an inhaled corticosteroid (ICS) with 24-hour activity in development as a once-daily treatment for the long-term management of asthma. Objective: To assess the efficacy and safety of 4 doses of once-daily FF administered using a dry powder inhaler in patients (>12 years) with moderate asthma, uncontrolled on low-dose ICS (fluticasone propionate [FP] 200 mu g/day or equivalent). Methods: This double-blind, placebo-controlled, dose-ranging study randomized 622 patients to 1 of 6 treatments: FF (100, 200, 300, or 400 mu g) once daily in the evening, FP 250 mu g twice daily (active control), or placebo for 8 weeks. The primary endpoint was the change from baseline in predose evening forced expiratory colume in 1 second (FEV1) at week 8. Results: At week 8, relative to placebo, all doses of FF once daily and FP twice daily demonstrated significantly (P < .001) greater increases from baseline and greater than 200-mL increases in predose FEV1. There was no evidence of a dose-response relationship between FF doses. Improvement with once-daily FF was similar to or greater than that for twice-daily FP. Secondary efficacy endpoint findings generally supported the efficacy of FF 100 to 400 mu g once daily, although statistically significant improvements versus placebo in symptom-free 24-hour periods were only reported for FF 400 mu g. There were few withdrawals due to lack of efficacy. Oral candidiasis was reported in 0 to 4% of patients; 24-hour urinary cortisol excretion ratios were similar across active treatment groups and not significantly different from placebo. Conclusion: FF 100 to 400 mu g once daily in the evening is effective and well tolerated in patients with asthma uncontrolled on low-dose ICS, with 100 mu g and 200 mu g, considered the most applicable doses in this asthma population. Trial Registration: clinicaltrials.gov Identifier: NCT00603278. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.