מתוך medicontext.co.il
By David Douglas
NEW YORK (Reuters Health) – Asthma therapy with fluticasone propionate leads to a greater degree of hypothalamic-pituitary-adrenal (HPA) axis suppression than does treatment with flunisolide.
Dr. Thomas B. Casale of Creighton University, Omaha, Nebraska, and colleagues note that the amount of inhaled corticosteroid that "enters and stays in the circulation, where it can affect HPA-axis activity varies among drugs of this class."
To compare such effects, the researchers conducted an open-label study of 153 asthma patients who were randomized to flunisolide 500 or 1000 µg twice daily, fluticasone 110, 220, 330, or 440 µg twice daily, oral prednisone 7.5 mg daily, or placebo. The findings are published in the November issue of the Annals of Allergy, Asthma, and Immunology.
In the 125 patients evaluated at the end of the 21-day study, serum cortisol suppression was significant for all dose groups except flunisolide 500 mcg twice daily and was highest in the oral corticosteroid group.
Dose-dependent suppression of the HPA-axis was significantly greater for fluticasone than for flunisolide. Dose-potency estimates indicated that fluticasone conferred a 4.4 times greater serum cortisol suppression per microgram increase in dosage than did flunisolide. Salivary and urinary cortisol gave quantitatively similar results.
Furthermore, with fluticasone and with prednisone, cortisol suppression was more persistent. With flunisolide, it was restricted mainly to the hours from 10 pm to 4 am and noon to 4 pm.
The findings, Dr. Casale told Reuters Health, show that "some inhaled corticosteroids can induce suppression of the HPA axis at the recommended doses for the treatment of asthma. Furthermore, there appears to be differences in the potency of different steroids to induce the suppressive effects."
Because of this, clinicians should "always monitor their patients closely using the lowest dose of inhaled steroids to maintain control of the asthma and be cognizant of the potential differences of the preparations of inhaled steroids." In addition, he pointed out, "patients should be informed of the risk/benefit ratios of these drugs, which still are the best treatments for chronic persistent asthma."
In an accompanying editorial, Dr. Brian J. Lipworth of the University of Dundee, in Scotland, also stresses the need for a vigilant approach, particularly when prescribing agents like fluticasone "which have a greater propensity for dose-related systemic adverse effects."
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