Maintaining asthma control in persistent asthma: Comparison of three strategies in a 6-month double-blind randomised study

SummaryIn patients controlled with SFC250 Diskus bd, this double-blind, randomised 6-month study compared continuing SFC250 to stepping down to either SFC100 bd or FP250 bd. Six hundred and three patients previously using 1000 μg BDP (or equivalent) daily +LABA and controlled according to investigator's judgement were recruited. Patients received SFC250 bd during an 8-week open run-in period. Four hundred and seventy six patients (mean age = 43 years, mean FEV1 = 2.9 ± 1.0) who fulfilled the randomisation criterion (‘Well-controlled’ asthma according to the GOAL weekly definition for the last 2 weeks of the run-in period) entered a 24-week treatment period. The statistical hypothesis was based on a non-inferiority of SFC100 or FP250 compared to SFC250. The main criterion was the change from baseline in morning PEF over weeks 1–12 in the per-protocol population. The non-inferiority limit was −15 L/min. At inclusion, the three treatment groups were well balanced. Mean morning PEF was 476, 470 and 465 L/min in the SFC250, SFC100 and FP250 groups, respectively. The adjusted mean change in morning PEF over weeks 1–12 was +1.76 ± 2.43 L/min for SFC250, −3.07 ± 2.32 L/min for SFC100 and −16.51 ± 2.46 L/min for FP250. SFC100 was at least as effective as SFC250 (treatment difference −4.83 [−12.39; 2.72], p = 0.151) whereas FP250 was not (treatment difference −18.27 [−26.05; −10.49], p < 0.001). Similar results were observed over weeks 13–24 in morning PEF (SFC100–SFC250 = −4.54 ± 3.84, p = 0.238; FP250–SFC250 = −20.11 ± 3.92, p < 0.0001). Secondary endpoints showed a similar pattern. Over weeks 1–12, SFC250 was significantly more effective than FP250 on evening PEF, daily symptoms and bronchodilator use. There was no difference between SFC100 and SFC250. The mean annual rate of moderate exacerbations was 0.16 in both SFC 250 and SFC 100 groups, and 0.21 in FP 250 group (ns, Poisson analysis). All treatments were well tolerated.ConclusionIn patients achieving asthma control with SFC250, stepping treatment down with SFC100 was at least as effective on lung function and symptoms as continuing SFC250, whereas FP250 was not.