Potential As-Needed Alternative to Budesonide Identified for Mild Asthma
As-needed budesonide-formoterol is noninferior to twice-daily maintenance treatment with budesonide alone for the management of mild asthma, a new study found.1
Because patients with mild asthma often have poor adherence to maintenance therapy, as-needed budesonide-formoterol may be a viable alternative for this patient population.
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Both treatment options were compared in a 52-week multicenter trial including 4215 patients aged 12 years or older with mild asthma who were eligible for treatment with regular inhaled glucocorticoids. Of these patients, 4176 were included in the present analysis.
Patients were randomly assigned to receive either twice-daily placebo plus 200 μg budesonide and 6 μg formoterol used as needed (n = 2089), or budesonide maintenance therapy with twice-daily 200 μg budesonide plus 0.5 μg terbutaline used as needed (n = 2087).
The Asthma Control Questionnaire-5 (ACQ-5) was used to assess changes in symptoms.
Results revealed that budesonide-formoterol used as needed was noninferior to budesonide maintenance therapy with respect to the rate of severe exacerbations (annualized rate: 0.11 vs 0.12; rate ratio 0.97).
However, budesonide-formoterol “was inferior [to budesonide maintenance therapy] in controlling symptoms” the researchers wrote.
Ultimately, change in ACQ-5 score indicated a difference of 0.11 units in favor of budesonide maintenance therapy.
The researchers noted that the median daily metered dose of inhaled glucocorticoid was lower in the budesonide-formoterol group than in the budesonide maintenance group (66 μg vs 267 μg). In addition, time to the first exacerbation was found to be similar between groups (hazard ratio 0.96).
“If patients could remember to take their maintenance budesonide treatment and follow it carefully, they would get the best day-to-day symptom control, but the risk of exacerbation was the same as if they used the combined budesonide and formoterol as needed,” the researchers concluded.2
—Christina Vogt
Reference:
1. Bateman ED, Reddel HK, O’Byrne PM, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma [Published online May 17, 2018]. N Eng J Med. doi: 10.1056/NEJMoa1715275
2. International study suggests alternative treatment for mild asthma [press release]. Hamilton, ON. May 16, 2018. https://brighterworld.mcmaster.ca/articles/international-study-suggests-alternative-treatment-for-mild-asthma/
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