title: Safety, efficacy, and dose response of fluticasone propionate delivered via the novel MDPI in patients with severe asthma: A randomized, controlled, dose-ranging study.
abstract: OBJECTIVE
  Evaluate fluticasone propionate (Fp) using a novel, inhalation-driven, multidose dry powder inhaler (MDPI) in patients with severe persistent asthma, versus placebo MDPI and Fp dry powder inhaler (DPI).
  
  
  METHODS
  Patients with persistent asthma despite use of high-dose inhaled corticosteroids were randomized to Fp MDPI 50, 100, 200, or 400 mcg; Fp DPI 250 mcg; or placebo MDPI twice daily for 12 weeks. The primary outcome measure was change from baseline in trough forced expiratory volume in 1 second (FEV1) over the 12-week period, compared with placebo; secondary measures included change from baseline in peak expiratory flow (PEF), rescue inhaler use, and time to withdrawal due to meeting stopping criteria. Safety included adverse events and laboratory evaluations.
  
  
  RESULTS
  Six hundred forty patients were randomized; 459 (72%) completed the study. Numerical dose-related improvements in FEV1were observed in all Fp MDPI groups over 12 weeks but were not significantly greater versus placebo. Increases in morning PEF (baseline to week 12) were substantially greater than placebo in all Fp MDPI groups. The Fp MDPI and Fp DPI groups had substantial reductions in rescue inhaler use from baseline to end point versus placebo (p ≤ 0.05). Efficacy was comparable between Fp MDPI and Fp DPI. No new safety signals were detected; the safety profile of Fp MDPI was similar to that of Fp DPI.
  
  
  CONCLUSIONS
  Clinical benefit observed with Fp MDPI in patients with persistent asthma was comparable to Fp DPI. Safety was reassuring with no unexpected findings. These results support further evaluation of Fp MDPI in asthma. (ClinicalTrials.gov identifier NCT01576718; EudraCT number 2010-023601-35).
authors.affiliation: a Division of Immunology, Allergy and Rheumatology , University of Cincinnati College of Medicine , Cincinnati , OH , USA.|b Bernstein Clinical Research Center , Cincinnati , OH , USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Bernstein
authors.affiliation: c Teva Pharmaceuticals , Frazer , PA , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gillespie
authors.affiliation: c Teva Pharmaceuticals , Frazer , PA , USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Song
authors.affiliation: c Teva Pharmaceuticals , Frazer , PA , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Steinfeld
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D058995:Dry Powder Inhalers; D005260:Female; D000068298:Fluticasone / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D006207:Half-Life; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D012129:Respiratory Function Tests; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D000068298:Fluticasone
keywords: Corticosteroid; dry powder inhalers; inhalation-driven; multidose; persistent asthma