Asthma control can be maintained when fluticasone propionate/salmeterol in a single inhaler is stepped down

Background

Asthma control is the goal of treatment, but little data exist to support treatment strategies for stepping down treatment once control has been achieved.

Objective

We assessed whether either the long-acting β₂-agonist or corticosteroid could be reduced without loss of asthma control once control had been attained with fluticasone propionate/salmeterol (FSC).

Methods

After 12 weeks of open-label treatment with FSC 250/50 μg twice daily, patients whose asthma was well controlled were randomized to FSC 100/50 μg twice daily or fluticasone propionate (FP) 250 μg twice daily. for 12 weeks. The primary endpoint was mean morning peak expiratory flow over the randomized study period. Secondary endpoints included symptom scores, rescue albuterol use, and asthma control.

Results

During open-label treatment, improvements from baseline were seen, and 435 of 641 patients (68%) achieved well controlled status during each of the last 4 weeks of this period. A total of 246 patients received FSC 100/50 μg twice daily and 238 FP 250 μg twice daily. The adjusted mean change in morning peak expiratory flow from the end of open-label treatment was −0.3 L/min for FSC and −13.2 L/min for FP (treatment difference, 12.9 L/min; 95% CI, 8.1-17.6; P < .001). Secondary efficacy endpoints also showed FSC 100/50 μg twice daily to be more effective than FP 250 μg twice daily alone. The majority of patients remained well controlled, but the proportion was higher with FSC.

Conclusion

In patients achieving asthma control with FSC 250/50 μg twice daily, stepping treatment down to a lower dose of FSC 100/50 μg twice daily is more effective than switching to an inhaled corticosteroid alone.

Key words: Asthma, fluticasone propionate, fluticasone propionate/salmeterol, maintenance, control, step-down

Abbreviations used: FP, Fluticasone propionate, FSC, Fluticasone propionate/salmeterol combination product, GOAL, Gaining Optimal Asthma ControL, ITT, Intent-to-treat, OR, Odds ratio, PEF, Peak expiratory flow, PP, Per protocol