Effects of the inhaled corticosteroids fluticasone propionate, triamcinolone acetonide, and flunisolide and oral prednisone on the hypothalamic-pituitary-adrenal axis in adult patients with asthma

Two multicenter, randomized, double-masked, placebo-controlled parallel-gro up studies were conducted in adult patients with mild-to-moderate persisten t asthma to assess the effects of 4 weeks of treatment with inhaled cortico steroids on hypothalamic-pituitary-adrenal (HPA) axis function. The first s tudy compared fluticasone propionate 100 and 500 mu g twice daily, triamcin olone acetonide 300 and 500 mu g twice daily, oral prednisone 10 mg every m orning, and placebo. The second study compared fluticasone propionate 100 a nd 250 mu g twice daily, flunisolide 500 mu g twice daily, and placebo. The rapeutic doses of fluticasone propionate, triamcinolone acetonide, and flun isolide were found to be comparable to each other and to placebo in their l ack of adrenal suppressive effects, based on mean plasma cortisol responses to 6-hour cosyntropin infusion. Prednisone produced significantly greater suppression of HPA-axis function than did any of the inhaled corticosteroid s or placebo (P < 0.001). Mean reductions from baseline in 8-hour area unde r the plasma concentration-time curve (AUC) and 8-hour peak plasma cortisol concentrations and the mean percentage of change from baseline in 8-hour A UC were significantly greater after treatment with triamcinolone acetonide 500 mu g twice daily compared with placebo (P less than or equal to 0.042). These findings indicate that fluticasone propionate has no greater systemi c effect than either triamcinolone acetonide or flunisolide at doses approp riate for patients with mild-to-moderate persistent asthma.