Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes: A systematic literature review and meta-analysis

Céline El Baou, Rachael L. Di Santostefano, Rafael Alfonso-Cristancho, Elizabeth A. Suarez, David Stempel, Mark L. Everard, Neil Barnes

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Inhaled corticosteroids (ICS) are the primary treatment for persistent asthma. Currently available ICS have differing particle size due to both formulation and propellant, and it has been postulated that this may impact patient outcomes. This structured literature review and meta-analysis compared the effect of small and standard particle size ICS on lung function, symptoms, rescue use (when available) and safety in patients with asthma as assessed in head-to-head randomized controlled trials (RCTs). Methods: A systematic literature search of MEDLINE was performed to identify RCTs (1998-2014) evaluating standard size (fluticasone propionate-containing medications) versus small particle size ICS medication in adults and children with asthma. Efficacy outcomes included forced expiratory volume in 1 s (FEV1), morning peak expiratory flow (PEF), symptom scores, % predicted forced expiratory flow between 25 and 75% of forced vital capacity (FEF25-75%), and rescue medication use. Safety outcomes were also evaluated when available. Results: Twenty-three independent trials that met the eligibility criteria were identified. Benefit-risk plots did not demonstrate any clinically meaningful differences across the five efficacy endpoints considered and no appreciable differences were noted for most safety endpoints. Meta-analysis results, using a random-effects model, demonstrated no significant difference between standard and small size particle ICS medications in terms of effects on mean change from baseline FEV1 (L) (-0.011, 95% confidence interval [CI]: -0.037, 0.014 [N = 3524]), morning PEF (L/min) (medium/low doses: -3.874, 95% CI: -10.915, 3.166 [N = 1911]; high/high-medium doses: 5.551, 95% CI: -1.948, 13.049 [N = 749]) and FEF25-75% predicted (-2.418, 95% CI: -6.400; 1.564 [N = 115]). Conclusions: Based on the available literature, no clinically significant differences in efficacy or safety were observed comparing small and standard particle size ICS medications for the treatment of asthma. Trial registration: GSK Clinical Study Register No: 202012.

Original languageEnglish
Article number31
JournalBMC Pulmonary Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - 7 Feb 2017

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Particle Size
Meta-Analysis
Adrenal Cortex Hormones
Asthma
Safety
Confidence Intervals
Forced Expiratory Volume
Randomized Controlled Trials
Vital Capacity
Patient Safety
MEDLINE
Lung
Therapeutics

Cite this

El Baou, Céline ; Di Santostefano, Rachael L. ; Alfonso-Cristancho, Rafael ; Suarez, Elizabeth A. ; Stempel, David ; Everard, Mark L. ; Barnes, Neil. / Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes : A systematic literature review and meta-analysis. In: BMC Pulmonary Medicine. 2017 ; Vol. 17, No. 1.
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abstract = "Background: Inhaled corticosteroids (ICS) are the primary treatment for persistent asthma. Currently available ICS have differing particle size due to both formulation and propellant, and it has been postulated that this may impact patient outcomes. This structured literature review and meta-analysis compared the effect of small and standard particle size ICS on lung function, symptoms, rescue use (when available) and safety in patients with asthma as assessed in head-to-head randomized controlled trials (RCTs). Methods: A systematic literature search of MEDLINE was performed to identify RCTs (1998-2014) evaluating standard size (fluticasone propionate-containing medications) versus small particle size ICS medication in adults and children with asthma. Efficacy outcomes included forced expiratory volume in 1 s (FEV1), morning peak expiratory flow (PEF), symptom scores, {\%} predicted forced expiratory flow between 25 and 75{\%} of forced vital capacity (FEF25-75{\%}), and rescue medication use. Safety outcomes were also evaluated when available. Results: Twenty-three independent trials that met the eligibility criteria were identified. Benefit-risk plots did not demonstrate any clinically meaningful differences across the five efficacy endpoints considered and no appreciable differences were noted for most safety endpoints. Meta-analysis results, using a random-effects model, demonstrated no significant difference between standard and small size particle ICS medications in terms of effects on mean change from baseline FEV1 (L) (-0.011, 95{\%} confidence interval [CI]: -0.037, 0.014 [N = 3524]), morning PEF (L/min) (medium/low doses: -3.874, 95{\%} CI: -10.915, 3.166 [N = 1911]; high/high-medium doses: 5.551, 95{\%} CI: -1.948, 13.049 [N = 749]) and FEF25-75{\%} predicted (-2.418, 95{\%} CI: -6.400; 1.564 [N = 115]). Conclusions: Based on the available literature, no clinically significant differences in efficacy or safety were observed comparing small and standard particle size ICS medications for the treatment of asthma. Trial registration: GSK Clinical Study Register No: 202012.",
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Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes : A systematic literature review and meta-analysis. / El Baou, Céline; Di Santostefano, Rachael L.; Alfonso-Cristancho, Rafael; Suarez, Elizabeth A.; Stempel, David; Everard, Mark L.; Barnes, Neil.

In: BMC Pulmonary Medicine, Vol. 17, No. 1, 31, 07.02.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of inhaled corticosteroid particle size on asthma efficacy and safety outcomes

T2 - A systematic literature review and meta-analysis

AU - El Baou, Céline

AU - Di Santostefano, Rachael L.

AU - Alfonso-Cristancho, Rafael

AU - Suarez, Elizabeth A.

AU - Stempel, David

AU - Everard, Mark L.

AU - Barnes, Neil

PY - 2017/2/7

Y1 - 2017/2/7

N2 - Background: Inhaled corticosteroids (ICS) are the primary treatment for persistent asthma. Currently available ICS have differing particle size due to both formulation and propellant, and it has been postulated that this may impact patient outcomes. This structured literature review and meta-analysis compared the effect of small and standard particle size ICS on lung function, symptoms, rescue use (when available) and safety in patients with asthma as assessed in head-to-head randomized controlled trials (RCTs). Methods: A systematic literature search of MEDLINE was performed to identify RCTs (1998-2014) evaluating standard size (fluticasone propionate-containing medications) versus small particle size ICS medication in adults and children with asthma. Efficacy outcomes included forced expiratory volume in 1 s (FEV1), morning peak expiratory flow (PEF), symptom scores, % predicted forced expiratory flow between 25 and 75% of forced vital capacity (FEF25-75%), and rescue medication use. Safety outcomes were also evaluated when available. Results: Twenty-three independent trials that met the eligibility criteria were identified. Benefit-risk plots did not demonstrate any clinically meaningful differences across the five efficacy endpoints considered and no appreciable differences were noted for most safety endpoints. Meta-analysis results, using a random-effects model, demonstrated no significant difference between standard and small size particle ICS medications in terms of effects on mean change from baseline FEV1 (L) (-0.011, 95% confidence interval [CI]: -0.037, 0.014 [N = 3524]), morning PEF (L/min) (medium/low doses: -3.874, 95% CI: -10.915, 3.166 [N = 1911]; high/high-medium doses: 5.551, 95% CI: -1.948, 13.049 [N = 749]) and FEF25-75% predicted (-2.418, 95% CI: -6.400; 1.564 [N = 115]). Conclusions: Based on the available literature, no clinically significant differences in efficacy or safety were observed comparing small and standard particle size ICS medications for the treatment of asthma. Trial registration: GSK Clinical Study Register No: 202012.

AB - Background: Inhaled corticosteroids (ICS) are the primary treatment for persistent asthma. Currently available ICS have differing particle size due to both formulation and propellant, and it has been postulated that this may impact patient outcomes. This structured literature review and meta-analysis compared the effect of small and standard particle size ICS on lung function, symptoms, rescue use (when available) and safety in patients with asthma as assessed in head-to-head randomized controlled trials (RCTs). Methods: A systematic literature search of MEDLINE was performed to identify RCTs (1998-2014) evaluating standard size (fluticasone propionate-containing medications) versus small particle size ICS medication in adults and children with asthma. Efficacy outcomes included forced expiratory volume in 1 s (FEV1), morning peak expiratory flow (PEF), symptom scores, % predicted forced expiratory flow between 25 and 75% of forced vital capacity (FEF25-75%), and rescue medication use. Safety outcomes were also evaluated when available. Results: Twenty-three independent trials that met the eligibility criteria were identified. Benefit-risk plots did not demonstrate any clinically meaningful differences across the five efficacy endpoints considered and no appreciable differences were noted for most safety endpoints. Meta-analysis results, using a random-effects model, demonstrated no significant difference between standard and small size particle ICS medications in terms of effects on mean change from baseline FEV1 (L) (-0.011, 95% confidence interval [CI]: -0.037, 0.014 [N = 3524]), morning PEF (L/min) (medium/low doses: -3.874, 95% CI: -10.915, 3.166 [N = 1911]; high/high-medium doses: 5.551, 95% CI: -1.948, 13.049 [N = 749]) and FEF25-75% predicted (-2.418, 95% CI: -6.400; 1.564 [N = 115]). Conclusions: Based on the available literature, no clinically significant differences in efficacy or safety were observed comparing small and standard particle size ICS medications for the treatment of asthma. Trial registration: GSK Clinical Study Register No: 202012.

KW - Asthma

KW - Inhaled corticosteroids

KW - Meta-analysis

KW - Particle size

KW - Systematic review

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DO - 10.1186/s12890-016-0348-4

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VL - 17

JO - B M C Pulmonary Medicine

JF - B M C Pulmonary Medicine

SN - 1471-2466

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ER -