title: A novel intranasal therapy of azelastine with fluticasone for the treatment of allergic rhinitis.
abstract: BACKGROUND
  Moderate-to-severe allergic rhinitis (AR) is a challenge to treat, with many patients using multiple therapies and achieving limited symptom control. More effective therapies must be developed and tested in well-controlled, randomized, prospective studies with a direct comparison to current standards.
  
  
  OBJECTIVE
  The aim of these studies was to investigate the efficacy of MP29-02 (a novel formulation of azelastine and fluticasone propionate [FP]) in patients with moderate-to-severe seasonal allergic rhinitis (SAR) and to compare its efficacy with 2 first-line therapies (ie, intranasal azelastine and intranasal FP) in this population.
  
  
  METHODS
  Three thousand three hundred ninety-eight patients (≥12 years old) with moderate-to-severe SAR were enrolled into 3 multicenter, randomized, double-blind, placebo- and active-controlled, parallel-group trials (MP4002 [NCT00651118], MP4004 [NCT00740792], and MP4006 [NCT00883168]). Each trial was conducted for 14 days during different allergy seasons. The primary efficacy variable was the sum of the morning and evening change from baseline in reflective total nasal symptom score (range, 0-24) over the treatment period. Outcomes for the meta-analysis included efficacy according to disease severity and time to response in relevant responder criteria.
  
  
  RESULTS
  In the meta-analysis MP29-02 reduced the mean reflective total nasal symptom score from baseline (-5.7 [SD, 5.3]) more than FP (-5.1 [SD, 4.9], P < .001), azelastine (-4.4 [SD, 4.8], P < .001), or placebo (-3.0 [SD, 4.2], P < .001). This benefit was observed from the first day of assessment, with improvement in each individual nasal symptom, even in the patients with the most severe disease. MP29-02 achieved response consistently days earlier and showed greater efficacy in patients with moderate-to-severe rhinitis than FP and azelastine.
  
  
  CONCLUSIONS
  MP29-02 represents a novel therapy that demonstrated superiority to 2 first-line therapies for AR. Patients with moderate-to-severe SAR achieved better control, and their symptoms were controlled earlier with MP29-02 than with recommended medications according to guidelines.
authors.affiliation: Allergy and Asthma Associates of Southern California, Mission Viejo, CA 92691, USA. wcarr@allergee.com
authors.forename: Warner
authors.initials: W
authors.lastname: Carr
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bernstein
authors.forename: Phil
authors.initials: P
authors.lastname: Lieberman
authors.forename: Eli
authors.initials: E
authors.lastname: Meltzer
authors.forename: Claus
authors.initials: C
authors.lastname: Bachert
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Ullrich
authors.initials: U
authors.lastname: Munzel
authors.forename: Jean
authors.initials: J
authors.lastname: Bousquet
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D018450:Disease Progression; D004338:Drug Combinations; D005260:Female; D000068298:Fluticasone; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010793:Phthalazines / Q000008:administration & dosage* / Q000009:adverse effects / Q000737:chemistry; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012621:Seasons; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000730:Androstadienes; D004338:Drug Combinations; C573864:MP29-02; D010793:Phthalazines; D000068298:Fluticasone; C020976:azelastine