Real-world effects of once-daily inhaled steroid (fluticasone furoate) combined with long-acting beta-2 agonist (vilanterol) and long-acting muscarinic antagonist (umeclidinium) on lung function tests of asthma patients in Japan

Frontiers in Physiology

Physiology

Tateki Yamane¹  Akira Umeda²  Yasumasa Okada³  Hiroshi Takeda⁴  Atsumi Mochida⁵  Kazuya Miyagawa⁵  Kenji Tsushima⁶  Hisato Shimada⁷  Koichi Fukunaga⁸  Masako Matsusaka⁸  Katsunori Masaki⁸  Taichi Mochizuki⁹  Yasushi Inoue⁹ 

[1] Department of Digestive Organ, IUHW Shioya Hospital, Yaita, Japan;Department of General Medicine, School of Medicine, International University of Health and Welfare (IUHW), IUHW Shioya Hospital, Yaita, Japan;Department of Respiratory Medicine, IUHW Shioya Hospital, Yaita, Japan;Department of Internal Medicine, National Hospital Organization Murayama Medical Center, Musashimurayama, Japan;Department of Pharmacology, School of Pharmacy at Fukuoka, International University of Health and Welfare, Fukuoka, Japan;Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Otawara, Japan;Department of Pulmonary Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan;Department of Respiratory Medicine, IUHW Shioya Hospital, Yaita, Japan;Division of Pulmonary Medicine, Department of Medicine, Keio University, Tokyo, Japan;Respiratory Diseases Center, IUHW Mita Hospital, Tokyo, Japan;

关键词: asthma;    fluticasone furoate;    vilanterol;    umeclidinium;    small airways;    peripheral airways;   

DOI  :  10.3389/fphys.2023.1131949

 received in 2022-12-26, accepted in 2023-04-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background: The Japanese drug use system allowed the once-daily use of inhaled corticosteroid fluticasone furoate (FF) combined with a long-acting beta-2 agonist vilanterol (VI) and a long-acting muscarinic antagonist umeclidinium (UMEC) against asthma on 18 February 2021. We investigated the real-world effects of these drugs (FF/UMEC/VI) mainly on lung function tests.Methods: This was an open-label, uncontrolled, within-group time-series (before-after) study. Prior asthma treatment (inhaled corticosteroid with/without a long-acting beta-2 agonist with/without a long-acting muscarinic antagonist) was switched to FF/UMEC/VI 200/62.5/25 μg. Subjects were evaluated by lung function tests prior to, and 1–2 months after, initiation of FF/UMEC/VI 200/62.5/25 μg. Patients were asked questions regarding the asthma control test and preference for drugs.Results: Overall, 114 asthma outpatients (97% Japanese) were enrolled from February 2021 to April 2022: 104 subjects completed the study. Forced expiratory volume in 1 s, peak flow, and asthma control test score of FF/UMEC/VI 200/62.5/25 μg-treated subjects were significantly increased (p < 0.001, p < 0.001, and p < 0.01, respectively). In contrast with FF/VI 200/25 μg, instantaneous flow at 25% of the forced vital capacity and expiratory reserve volume were significantly increased by FF/UMEC/VI 200/62.5/25 μg (p < 0.01, p < 0.05, respectively). Sixty-six percent of subjects declared they wanted to continue FF/UMEC/VI 200/62.5/25 μg in the future. Adverse effects, mainly local, were seen in 30% of patients, but no serious adverse effects were seen.Conclusion: Once-daily FF/UMEC/VI 200/62.5/25 μg was effective against asthma without serious adverse events. This is the first report that demonstrated FF/UMEC/VI dilated peripheral airways using lung function tests. This evidence on drug effects may improve our understanding of pulmonary physiology and the pathophysiology of asthma.

【 授权许可】

Unknown   
Copyright © 2023 Umeda, Shimada, Yamane, Mochizuki, Inoue, Tsushima, Miyagawa, Mochida, Takeda, Okada, Masaki, Matsusaka and Fukunaga.