A randomized, double-blind comparison of beclomethasone dipropionate extrafine aerosol and fluticasone propionate

Background: Inhaled corticosteroids provide first-line treatment for asthma. An advance to improve potency was to produce new molecules with increased glucocorticoid receptor affinity (eg, fluticasone propionate [FP]). An alternative is to deliver more medication to both the large and small airway inflammation of asthma by using an extrafine aerosol (eg, beclomethasone dipropionate extrafine aerosol [BDP-extrafine]). Objective: To demonstrate clinical equivalence of BDP-extrafine (400 mug daily) and FP (400 mug daily) in symptomatic asthmatic patients over the course of 6 weeks. Methods: This was a double-blind, double-dummy, parallel-group, multicenter, 6-week study in adults with asthma taking conventional FP 1010 to 250 mug daily or equivalent, and displaying signs/symptoms of active disease requiring additional therapy. Results: Eighty-eight patients were randomized to BDP-extrafine (and FP-placebo) and 84 to FP (and BDP-placebo). There were no significant differences between treatments with respect to symptom control, as evidenced by mean change from baseline in percentage days without asthma symptoms/nights without sleep disturbance observed at weeks 1 to 2, 3 to 4, or 5 to 6. Mean changes from baseline in AM PEFR at weeks 5 to 6 for BDP-extrafine (19.0) and FP (30.5) were equivalent (P = 0.022 for equivalence). There were significant (P < 0.001) within-treatment-group differences in mean change from baseline in AM PEFR at weeks 1 to 2 for both treatments. There was no difference in the incidence of patients reporting at least one adverse event during the study (BDP-extrafine 41%; FP 37%). Mean percentage change from baseline for AM plasma cortisol at week 6 was +17.7% for BDP-extrafine and +4.2% for FP (P = 0.066 for difference). Conclusions: BDP-extrafine and FP at doses of 400 <mu>g daily provided equivalent asthma control in patients with symptomatic asthma and exhibited similar safety profiles.