Extrafine HFA-beclomethasone-formoterol vs. nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist in patients with persistent asthma: A systematic review and meta-analysis.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Adrenal Cortex Hormones/*therapeutic use ; Adrenergic beta-2 Receptor Agonists/*therapeutic use ; Asthma/*drug therapy ; Beclomethasone/*therapeutic use ; Formoterol Fumarate/*therapeutic use ; Hydrocarbons, Fluorinated/*therapeutic use; Administration, Inhalation ; Adolescent ; Adrenal Cortex Hormones/administration & dosage ; Adrenal Cortex Hormones/adverse effects ; Adrenergic beta-2 Receptor Agonists/adverse effects ; Adult ; Aged ; Beclomethasone/adverse effects ; Female ; Formoterol Fumarate/adverse effects ; Humans ; Hydrocarbons, Fluorinated/adverse effects ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Publication Bias ; Risk ; Young Adult

Objective: Airway inflammation in asthma involves not only the central airways but extends to peripheral airways. Lung deposition may be key for an appropriate treatment of asthma. We compared the clinical effects of extrafine hydrofluoroalkane (HFA)-beclomethasone-formoterol (BDP-F) versus equipotent doses of nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist (ICS-LABA) in asthma.
Methods: We identified eligible studies by a comprehensive literature search of PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Data analysis was performed with the Review Manager 5.3.5 software (Cochrane IMS, 2014).
Results: A total of 2326 patients with asthma from ten published randomized controlled trials (RCTs) were enrolled for analysis. Change from baseline in morning pre-dose peak expiratory flow (PEF), evening pre-dose PEF and forced expiratory volume in one second (FEV1) were detected no significant differences between extrafine HFA-BDP-F and nonextrafine ICS-LABAs (p = 0.23, p = 0.99 and p = 0.23, respectively). Extrafine HFA-BDP-F did not show any greater benefit in forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%), the parameter concerning peripheral airways (MD 0.03L/s, p = 0.65; n = 877). There were no substantial differences between interventions in fractional exhaled nitric oxide (FeNO) levels or in its alveolar fraction. The overall analysis showed no significant benefit of extrafine HFA-BDP-F over nonextrafine ICS-LABA in improving Asthma Control Test (ACT) score (p = 0.30) or decreasing the number of puffs of rescue medication use (p = 0.16). Extrafine HFA-BDP-F did not lead to less exacerbations than nonextrafine ICS-LABA (RR 0.61, 95% CI: 0.31 to 1.20; I2 = 0; p = 0.15).
Conclusion: Enrolled RCTs of extrafine HFA-BDP-F have demonstrated no significant advantages over the equivalent combination of nonextrafine ICS-LABA in improving pulmonary function concerning central airways or peripheral airways, improving asthma symptom control or reducing exacerbation rate.
Competing Interests: The authors have declared that no competing interests exist.

Eur Respir J. 2007 Apr;29(4):682-9. (PMID: 17107988)
Expert Opin Pharmacother. 2008 Feb;9(3):479-90. (PMID: 18220498)
J Allergy Clin Immunol. 2006 Aug;118(2):340-6. (PMID: 16890756)
Respir Res. 2001;2(6):333-9. (PMID: 11737932)
BMJ. 2015 Jan 02;350:g7647. (PMID: 25555855)
J Aerosol Med Pulm Drug Deliv. 2010 Jun;23(3):137-48. (PMID: 20109122)
Respir Med. 2012 Dec;106 Suppl 1:S9-19. (PMID: 23273165)
Respir Med. 2002 Aug;96 Suppl D:S3-8. (PMID: 12201079)
Respir Res. 2014 Aug 27;15:86. (PMID: 25158694)
Allergol Int. 2010 Mar;59(1):59-66. (PMID: 20035146)
Ann Allergy Asthma Immunol. 2012 Sep;109(3):185-189.e2. (PMID: 22920073)
Respir Med. 2009 Jan;103(1):41-9. (PMID: 18977646)
BMJ. 2011 Oct 18;343:d5928. (PMID: 22008217)
Respiration. 2010;80(2):120-6. (PMID: 19776554)
Allergy. 2010 Jul;65(7):897-902. (PMID: 20121764)
J Asthma Allergy. 2013;6:11-21. (PMID: 23378776)
Clin Exp Allergy. 2012 Aug;42(8):1150-60. (PMID: 22805462)
J Aerosol Med Pulm Drug Deliv. 2015 Apr;28(2):82-7. (PMID: 25050594)
J Formos Med Assoc. 2018 Dec;117(12):1078-1085. (PMID: 29292054)
Respir Med. 2012 Feb;106(2):205-14. (PMID: 22035853)
J Allergy Clin Immunol. 1997 Jul;100(1):44-51. (PMID: 9257786)
Allergy. 2007 Oct;62(10):1182-8. (PMID: 17845589)
BMC Pulm Med. 2011 Jul 15;11:40. (PMID: 21762500)
Expert Opin Drug Deliv. 2014 Sep;11(9):1497-506. (PMID: 24921434)
Respiration. 2005;72 Suppl 1:3-5. (PMID: 15915006)
J Allergy Clin Immunol. 2009 May;123(5):1090-7, 1097.e1. (PMID: 19361849)
Drugs. 2006;66(11):1475-83; discussion 1484-5. (PMID: 16906779)
J Allergy Clin Immunol. 1999 Dec;104(6):S258-67. (PMID: 10588987)
Respir Res. 2012 Jun 25;13:54. (PMID: 22731754)
Allergy Asthma Proc. 2011 Nov-Dec;32(6):29-34. (PMID: 22221427)
Eur Respir Rev. 2011 Mar;20(119):23-33. (PMID: 21357889)
Am Rev Respir Dis. 1991 Jan;143(1):138-43. (PMID: 1986670)
J Allergy Clin Immunol. 2009 Dec;124(6 Suppl):S88-93. (PMID: 19962042)
JAMA. 2014 Jul;312(2):171-9. (PMID: 25005654)
Pulm Pharmacol Ther. 2015 Apr;31:79-84. (PMID: 25194884)
J Allergy Clin Immunol. 2002 Feb;109(2 Suppl):S447-60. (PMID: 11842317)
Pulm Pharmacol Ther. 2013 Oct;26(5):555-61. (PMID: 23524015)
BMJ. 2003 Sep 6;327(7414):557-60. (PMID: 12958120)

0 (Adrenal Cortex Hormones)
0 (Adrenergic beta-2 Receptor Agonists)
0 (Hydrocarbons, Fluorinated)
KGZ1SLC28Z (Beclomethasone)
R40P36GDK6 (apaflurane)
W34SHF8J2K (Formoterol Fumarate)

Date Created: 20210903 Date Completed: 20211116 Latest Revision: 20211116

20240829

PMC8415610

10.1371/journal.pone.0257075

34478483