Stepping down to the lowest effective dose

Stepping down to the lowest effective dose

BTS/SIGN, NICE and GINA guidelines recommend that patients should be on the lowest effective dose of ICS that controls their asthma.1 – 3

The FFLUX study compared the effectiveness of switching adult patients controlled on Seretide® Evohaler® 250µg to flutiform 250µg.4

FFLUX was a pragmatic, open-label, randomised, non-inferiority trial that assessed the effectiveness of switching and stepping down to flutiform, with asthma control assessed according to ACQ7.4

Patients either remained on Seretide® Evohaler® 250/25µg, or were changed to flutiform 250/10µg. For phase II of the trial, 116 patients controlled on flutiform 250/10µg either remained on flutiform 250/10µg, or were stepped down to flutiform 125/5µg.

 

 

Patients who stepped across from Seretide® Evohaler® 250/25 µg to flutiform 250/10 µg experienced:

  • Non-inferior asthma control*4

    • according to ACQ7 questionnaire
    • difference in mean scores (95% CI): -0.12 (-0.32,0.09)
  • Significantly higher odds of being more controlled4

    • according to GINA Criteria3
    • odds ratio (95% CI): 2.00 (1.14,3.52), P = 0.016

 

Controlled patients who stepped down to flutiform 125/5µg:

  • Continued to benefit from good asthma control*4

    • difference in mean ACQ7 scores (95% CI): 0.01 (-0.20,0.22)

*The non-inferiority limit on the ACQ7 (7 item asthma control questionnaire) was set at 0.3

 

Read the Usmani OS et al, 2017 paper in full here

 

 

Webinar –
Stepping down treatment in asthma

For more information on the latest evidence and guidance on stepping down treatment in asthma, view this EDUCATIONAL WEBINAR

 

References

  1. SIGN 153. British guideline on the management of asthma https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/. [Accessed February 2018].
  2. NICE NG80. Asthma: diagnosis, monitoring and chronic asthma management, November 2017. https://www.nice.org.uk/guidance/ng80 [Accessed February 2018].
  3. Global Initiative for Asthma (GINA) 2017 Pocket Guide for Asthma Prevention. http://ginasthma.org/2017-pocket-guide-for-asthma-management-and-prevention/ [Accessed February 2018].
  4. Usmani OS, Kemppinen A, Gardener E, et al. Randomized pragmatic trial of changing to and stepping down fluticasone/formoterol in asthma. J Allergy Clin Immunol Pract. 2017 Sep - Oct;5(5):1378-1387.