DIFFERENTIAL-EFFECTS OF INHALED CORTICOSTEROIDS - FLUTICASONE PROPIONATE VERSUS TRIAMCINOLONE ACETONIDE

We conducted a double-blind, double-dummy, placebo-controlled trial to directly compare differences in clinical efficacy and effect on quali ty of life between fluticasone propionate and triamcinolone acetonide. A total of 304 male and female patients with asthma who were previous ly maintained on beclomethasone dipropionate or triamcinolone were ran domly assigned to 24 weeks of treatment with either fluticasone powder 250 mu g twice daily via a breath-actuated inhalation device, triamci nolone aerosol 200 mu g four times daily via metered dose inhaler, or placebo. At endpoint, the mean increase in forced expiratory volume in one second (FEV1) at endpoint was significantly greater in patients t reated with fluticasone (0.32L) than in patients treated with triamcin olone (0.03L) or placebo (-0.18L) (P < 0.001). Mean increase in mornin g peak expiratory flow at endpoint was 18 L/min with fluticasone compa red with mean decreases of 3 L/min and 24 L/min in the triamcinolone a nd placebo groups, respectively (P < 0.001) versus placebo and triamci nolone). After treatment with fluticasone, mean change from baseline t o endpoint in supplemental albuterol use, nighttime awakenings, probab ility of remaining in the study, and Asthma Quality of Life Questionna ire global scores was significantly improved compared with triamcinolo ne or placebo (P < 0.05). Low morning plasma cortisol concentration me asurements were infrequent and similar across treatment groups. Flutic asone powder administered twice daily (500 mu g/day) is more effective than triamcinolone aerosol administered four times daily (800 mu g/da y) with respect to number of nighttime awakenings, supplemental albute rol use, probability of remaining in the study, pulmonary function, an d quality of life measures without compromising adrenal function in pa tients with asthma.