Treatment of Persistent Asthma With Symbicort® (Budesonide/Formoterol Inhalation Aerosol): An Inhaled Corticosteroid and Long-Acting β2-Adrenergic Agonist in One Pressurized Metered-Dose Inhaler

Abstract

Objective. Budesonide/formoterol inhalation aerosol (Symbicort® AstraZeneca, Wilmington, Delaware) is an inhaled corticosteroid (ICS) and long-acting β2-adrenergic agonist (LABA) combination administered twice daily via one hydrofluoroalkane pressurized metered-dose inhaler (pMDI) approved in the United States for the long-term maintenance treatment of persistent asthma in patients ≥12 years of age whose asthma cannot be controlled by an ICS alone. The objective was to review efficacy, safety, and pharmacogenetic data on budesonide/formoterol pMDI in the treatment of persistent asthma. Methods. The authors searched PubMed and respiratory meeting databases to identify asthma studies of budesonide/formoterol pMDI. Studies involving traditional and patient-reported outcomes, safety, tolerability, or pharmacogenetics were included. Results. In two 12-week pivotal trials in adolescents and adults, treatment with budesonide/formoterol pMDI 160/4.5 μg × 2 inhalations (320/9 μg) twice daily for moderate to severe persistent asthma or 80/4.5 μg × 2 inhalations (160/9 μg) twice daily for mild to moderate persistent asthma, demonstrated greater efficacy and similar tolerability compared with placebo and the same nominal dose of its monocomponents. Comparisons with formoterol dry powder inhaler (DPI) for predose forced expiratory volume in one second (FEV1) and with budesonide pMDI for 12-hour mean postdose FEV1 demonstrated the anti-inflammatory and bronchodilatory contributions of budesonide and formoterol, respectively. Evaluations of patient-reported outcomes, including asthma-specific quality of life and treatment satisfaction, further supported the clinical benefits of budesonide/formoterol pMDI. In a 52-week tolerability study of patients aged ≥12 years, budesonide/formoterol pMDI was delivered at up to double the maximum dose (640/18 μg twice daily) and demonstrated a safety profile similar to that of budesonide (640 μg twice daily), with no unexpected pattern of abnormalities. Additional studies reported that budesonide/formoterol pMDI 320/9 μg twice daily and fluticasone propionate/salmeterol DPI 250/50 μg twice daily have similar efficacy and tolerability, with significantly more patients achieving ≥15% improvement in FEV1 within 15 minutes with budesonide/formoterol pMDI compared with fluticasone/salmeterol DPI. Moreover, inheritance of the Gly16Arg polymorphism of the β2-adrenergic receptor does not appear to affect clinical outcomes with budesonide/formoterol pMDI. Conclusion. Budesonide/formoterol pMDI administered twice daily is effective and generally well tolerated in patients whose asthma is not well controlled on ICS alone.