title: Equivalent Lung Dose and Systemic Exposure of Budesonide/Formoterol Combination via Easyhaler and Turbuhaler.
abstract: BACKGROUND
  Easyhaler(®) device-metered dry powder inhaler containing budesonide and formoterol fumarate dihydrate (hereafter formoterol) for the treatment of asthma and chronic obstructive pulmonary disease has been developed. The current approvals of the product in Europe were based on several pharmacokinetic (PK) bioequivalence (BE) studies, and in vitro-in vivo correlation (IVIVC) modeling.
  
  
  METHODS
  Four PK studies were performed to compare the lung deposition and total systemic exposure of budesonide and formoterol after administration of budesonide/formoterol Easyhaler and the reference product, Symbicort Turbuhaler. The products were administered concomitantly with oral charcoal (lung deposition) and in two of the studies also without charcoal (total systemic exposure). Demonstration of BE for lung deposition (surrogate marker for efficacy) and non-inferiority for systemic exposure (surrogate marker for safety) were considered a proof of therapeutic equivalence. In addition, IVIVC models were constructed to predict study outcomes with different reference product fine particle doses (FPDs).
  
  
  RESULTS
  In the first pivotal study, the exposure and lung dose via Easyhaler were higher compared to the reference product (mean comparison estimates between 1.07 and 1.28) as the FPDs of the reference product batch were low. In the following studies, reference product batches with higher FPDs were utilized. In the second pivotal study, non-inferiority of Easyhaler compared to Turbuhaler was shown in safety and BE in efficacy for all other parameters except the formoterol AUCt. In the fourth study where two reference batches were compared to each other and Easyhaler, budesonide/formoterol Easyhaler was bioequivalent with one reference batch but not with the other having the highest FPDs amongst the 28 reference batches studied. In the IVIVC based study outcome predictions, the test product was bioequivalent with great proportion of the reference batches. For the test product and the median FPD reference product BE was predicted.
  
  
  CONCLUSIONS
  Equivalence regarding both safety and efficacy between budesonide/formoterol Easyhaler and Symbicort Turbuhaler was shown based on totality of evidence from the PK studies and IVIVC analyses, and therefore, therapeutic equivalence between the products can be concluded. The results of the PK studies are likely dependent on the variability of FPDs of the reference product batches.
authors.affiliation: 1 Orion Corporation Orion Pharma , Espoo, Finland .
authors.forename: Satu
authors.initials: S
authors.lastname: Lähelmä
authors.affiliation: 1 Orion Corporation Orion Pharma , Espoo, Finland .
authors.forename: Ulla
authors.initials: U
authors.lastname: Sairanen
authors.affiliation: 1 Orion Corporation Orion Pharma , Espoo, Finland .
authors.forename: Jussi
authors.initials: J
authors.lastname: Haikarainen
authors.affiliation: 1 Orion Corporation Orion Pharma , Espoo, Finland .
authors.forename: Jani
authors.initials: J
authors.lastname: Korhonen
authors.affiliation: 1 Orion Corporation Orion Pharma , Espoo, Finland .
authors.forename: Mikko
authors.initials: M
authors.lastname: Vahteristo
authors.affiliation: 2 PAREXEL Early Phase Clinical Unit , Berlin, Germany .
authors.forename: Rainard
authors.initials: R
authors.lastname: Fuhr
authors.affiliation: 1 Orion Corporation Orion Pharma , Espoo, Finland .
authors.forename: Merja
authors.initials: M
authors.lastname: Kirjavainen
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000328:Adult; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D000069502:Budesonide, Formoterol Fumarate Drug Combination / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D058995:Dry Powder Inhalers; D004867:Equipment Design; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D008168:Lung / Q000378:metabolism*; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D008954:Models, Biological; D010865:Pilot Projects; D011208:Powders; D065589:Respiratory Tract Absorption; D013810:Therapeutic Equivalency; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D000069502:Budesonide, Formoterol Fumarate Drug Combination; D005938:Glucocorticoids; D011208:Powders
keywords: Easyhaler; Turbuhaler; budesonide; dry powder inhaler; formoterol; lung deposition; pharmacokinetics; therapeutic equivalence