背景:在第3阶段的曼陀罗试验中,与按需使用沙丁胺醇相比,按需使用沙丁胺醇-布地奈德加压定量吸入器(pMDI)可显著降低中重度哮喘患者的严重加重风险.进行这项研究(DENALI)是为了解决美国食品和药物管理局的组合规则,该规则要求组合产品证明每种成分都有助于其安全性或有效性。
目的:沙丁胺醇和布地奈德是否有助于沙丁胺醇-布地奈德联合pMDI治疗哮喘患者的疗效?
方法:这项3期双盲试验:年龄≥12岁的轻中度哮喘患者1:1:1:1:1:1至4次,每天沙丁胺醇-布地奈德180μg/160沙丁胺醇180μg,布地奈德160μg,或安慰剂12周。双主要疗效终点为12周内0-6小时(FEV1AUC0-6h)曲线下用力呼气容积面积的基线变化(评估沙丁胺醇效应)和第12周的FEV1谷(评估布地奈德效应)。
结果:在随机分组的1001名患者中,989例≥12年,疗效可评估。沙丁胺醇-布地奈德180/160μg与布地奈德160μg相比,FEV1AUC0-6h的基线变化更大(最小二乘均值[LSM]差异[95CI]80.7[28.4-132.9]mL;p=0.003)。沙丁胺醇-布地奈德180/160和180/80μg与沙丁胺醇180μg(LSM差异[95CI]132.8[63.6-201.9]mL和120.8[51.5-190.1]mL,分别;两者p<0.001)。沙丁胺醇-布地奈德支气管扩张的第1天发作时间和持续时间与沙丁胺醇相似。沙丁胺醇-布地奈德不良事件概况与单组分相似。
结论:两种单组分均有助于沙丁胺醇-布地奈德肺功能疗效。沙丁胺醇-布地奈德耐受性良好,即使是常规的相对较高的每日剂量持续12周,没有新的安全发现,支持将其用作一种新型的抢救疗法。
In the phase 3 MANDALA
trial, as-needed albuterol-budesonide pressurized metered-dose inhaler significantly reduced severe exacerbation risk vs as-needed albuterol in patients with moderate-to-severe asthma receiving inhaled corticosteroid-containing maintenance therapy. This
study (DENALI) was conducted to address the US Food and Drug Administration combination rule, which requires a combination product to demonstrate that each component contributes to its efficacy.
Do both albuterol and budesonide contribute to the efficacy of the albuterol-budesonide combination pressurized metered-dose inhaler in patients with asthma?
This phase 3 double-blind
trial randomized patients aged ≥ 12 years with mild-to-moderate asthma 1:1:1:1:1 to four-times-daily albuterol-budesonide 180/160 μg or 180/80 μg, albuterol 180 μg, budesonide 160 μg, or placebo for 12 weeks. Dual-primary efficacy end points included change from baseline in FEV1 area under the curve from 0 to 6 h (FEV1 AUC0-6h) over 12 weeks (assessing albuterol effect) and trough FEV1 at week 12 (assessing budesonide effect).
Of 1,001 patients randomized, 989 were ≥ 12 years old and evaluable for efficacy. Change from baseline in FEV1 AUC0-6h over 12 weeks was greater with albuterol-budesonide 180/160 μg vs budesonide 160 μg (least-squares mean [LSM] difference, 80.7 [95% CI, 28.4-132.9] mL; P = .003). Change in trough FEV1 at week 12 was greater with albuterol-budesonide 180/160 and 180/80 μg vs albuterol 180 μg (LSM difference, 132.8 [95% CI, 63.6-201.9] mL and 120.8 [95% CI, 51.5-190.1] mL, respectively; both P < .001). Day 1 time to onset and duration of bronchodilation with albuterol-budesonide were similar to those with albuterol. The albuterol-budesonide adverse event profile was similar to that of the monocomponents.
Both monocomponents contributed to albuterol-budesonide lung function efficacy. Albuterol-budesonide was well tolerated, even at regular, relatively high daily doses for 12 weeks, with no new safety findings, supporting its use as a novel rescue therapy.
ClinicalTrials.gov; No.: NCT03847896; URL: www.
gov.