Abstract

To investigate the effect of time of day of dosing (morning or evening) on lung function following administration of fluticasone furoate (FF)/vilanterol (VI) 100/25 mcg. Double-blind, placebo-controlled, randomised, three-way crossover study. Subjects with persistent asthma (N = 26) received FF/VI (morning or evening) or matching placebo once-daily for 14 (± 2 days) via dry powder inhaler (DPI). Weighted mean (0-24h) and pre-treatment FEV1 (morning and evening) were determined after the Day 14 evening dose, together with mean pre-treatment (morning and evening) peak expiratory flow (PEF) on Days 2-12. FF/VI 100/25 administered morning or evening produced clinically significant increases in weighted mean FEV1: the differences [95% confidence interval (CI)] from placebo were 377 mL [293, 462] and 422 mL [337, 507], respectively; the difference between morning and evening dosing was -44 mL [-125, 36]. Day 14 pre-treatment morning FEV1 differences [95% CI] from placebo were 403 mL [272, 533] and 496 mL [369, 624] after morning and evening dosing, respectively; the morning:evening treatment difference was -94 mL [-221, 34]. Pre-treatment evening FEV1 differences [95% CI] from placebo were 275 mL [169, 380] and 309 mL [205, 413] after morning and evening dosing, respectively; the morning:evening treatment difference was -34 mL [-138, 70]. FF/VI (morning or evening) produced rapid increases in PEF with the full effect apparent after the first dose and maintained throughout the 14-day treatment period. FF/VI 100/25 produces comparable improvements in lung function whether dosed in the morning or evening in subjects with persistent asthma.

Highlights

  • International guidelines advocate the use of an inhaled corticosteroid combined with a long-acting beta-agonist (ICS/LABA) for the maintenance therapy of asthma patients who remain symptomatic despite use of low-medium dose ICS alone [1,2]

  • Considerable evidence exists to support the concept that asthma is influenced by circadian rhythms, with symptoms worsening and lung function decreasing at night [15e19]

  • These time dependent effects of corticosteroid administration have been seen in asthma with evening dosing proving the most effective time for some once-daily ICS formulations with respect to lung function and reduction of side-effects relating to cortisol suppression [22e25]

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Summary

Introduction

MethodsInternational guidelines advocate the use of an inhaled corticosteroid combined with a long-acting beta-agonist (ICS/LABA) for the maintenance therapy of asthma patients who remain symptomatic despite use of low-medium dose ICS alone [1,2]. Considerable evidence exists to support the concept that asthma is influenced by circadian rhythms, with symptoms worsening and lung function decreasing at night [15e19]. Given this chronobiology of asthma, it is not surprising that time of administration has been shown to influence the efficacy of some bronchodilators with oncedaily dosing in the evening potentially being the most effective treatment paradigm [15,18e21]. These time dependent effects of corticosteroid administration have been seen in asthma with evening dosing proving the most effective time for some once-daily ICS formulations with respect to lung function and reduction of side-effects relating to cortisol suppression [22e25]. Having the flexibility of dosing either in the morning or evening may be more convenient for the patient and may further improve treatment adherence and the management of asthma symptoms

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