Systematic review of the dose-response relation of inhaled fluticasone propionate.
OBJECTIVE
To examine the dose-response relation of inhaled fluticasone for both efficacy and adrenal function in children with asthma.


METHODS
Systematic review of double blind randomised dose-response studies of fluticasone in children of at least 4 weeks duration.


METHODS
FEV1, morning peak expiratory flow, night awakenings, beta agonist use, major exacerbations, 12 or 24 hour urinary cortisol, peak plasma cortisol post-stimulation.


RESULTS
Seven studies of 1733 children with asthma met the inclusion criteria for efficacy. The dose-response curve for each efficacy outcome measure suggested that the response began to plateau between 100 and 200 microg per day with additional efficacy at the 400 microg per day dose shown in one study of severe asthmatics. Five studies of 1096 children with asthma met the inclusion criteria for assessment of adrenal function. The largest placebo controlled study of 437 children reported no difference in 24 hour urinary cortisol between placebo and fluticasone at doses of 100 and 200 microg per day. The non-placebo controlled study of 528 children reported significant suppression of overnight urinary cortisol levels with fluticasone at 400 compared with 200 microg per day.


CONCLUSIONS
There is insufficient data to determine the dose-response of fluticasone in children at doses >400 microg per day. The dose-response curve for fluticasone appears to plateau between 100 and 200 microg per day for efficacy. There was additional efficacy at the 400 microg per day dose in children with severe asthma; however there was evidence of adrenal suppression at this dose.
Masoli
M
M
Medical Research Institute of New Zealand, Wellington, New Zealand.
Weatherall
M
M
Holt
S
S
Beasley
R
R
D000280:Administration, Inhalation; D000730:Androstadienes / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone