Fluticasone in moderate-to-severe persistent asthma in adults

The objective of this article is to review, based on the analysis of two cl inical trials, the efficacy and safety of half-dose fluticasone compared to the doses of the other two inhaled corticosteroids (beclomethasone and bud esonide) used in moderate-to-severe persistent asthma. The first double-bli nd trial compared 1000 mu g/day of fluticasone versus 2000 mu g/day of becl omethasone for sh weeks in two parallel groups. The second trial, conducted according to the same methodology, compared 800 mu g/day of fluticasone ad ministered for twelve weeks versus 1600 mu g/day of budesonide. Both trials showed that fluticasone, at doses of 800 or 1000 mu g/day, is at least equ ivalent to 1600 mu g of budesonide or 2000 mu g of beclomethasone for the c ontrol of moderate-to-severe persistent asthma in adults. These clinical tr ials confirm that half-dose fluticasone is just as effective as the other i nhaled corticosteroids in moderate-to-severe persistent asthma. In these tw o trials, evaluation of systemic safety essentially concerned hypothalamic- pituitary-adrenal suppression. Both trials showed favourable effects of flu ticasone on the adrenal gland compared to the reference drug. However, the clinical relevance of these safety trials, exclusively based on hypothalami c-pituitary-adrenal suppression, is open to discussion. Other trials evalua ting bone safety appear to be more relevant to clinical practice. The benef it/risk ratio of fluticasone, based on analysis of efficacy and safety data , appears to he superior to that of other inhaled corticosteroids.