mometasone-furoate and azelastine

The present literature review had the objective to analyze the published data concerning the effectiveness of intranasal administration of antihistamine preparations and intranasal glucocorticoids for the treatment of allergic rhinitis. Special emphasis is placed on the clinical significance and the further prospects for the application of a fixed combination of these medications including azelastineplusmometasonefuroateas the first choice therapy of moderately severe and severe manifestations of allergic rhinitis.. Цель работы - проанализировать данные литературы, касающиеся эффективности интраназального применения антигистаминных препаратов и интраназальных гюкокортикостероидов при аллергическом рините. Подчеркнуты значение и перспективы применения фиксированной комбинации этих препаратов, в частности азеластина и мометазона фуроата, в качестве терапии первого выбора в лечении среднетяжелых и тяжелых проявлений аллергического ринита.

Topics: Administration, Intranasal; Drug Combinations; Glucocorticoids; Histamine Antagonists; Humans; Mometasone Furoate; Nasal Sprays; Phthalazines; Rhinitis, Allergic; Severity of Illness Index; Treatment Outcome

During the last few years, fixed combinations of intranasal antihistamines and corticosteroids have been introduced for treatment of allergic rhinitis. The aim of this systematic review was to assess recent patents and clinical evidence for fixed combinations of intranasal antihistamines and intranasal corticosteroids in allergic rhinitis. Data base searches revealed that intranasal combinations of the antihistamine azelastine with the corticosteroids mometasone furoate, ciclesonide and fluticasone propionate, respectively, have been patented. Four randomized, double-blinded, parallel-group, placebo-controlled, multicenter trials sponsored by the manufacturer evaluated the fixed combination of intranasal azelastine 125 µg and fluticasone propionate 50 µg administered as one dose per nostril b.i.d. in patients with moderate-to-severe symptomatic allergic rhinitis ≥ 12 years of age. Three of the studies were published as a meta-analysis which found the fixed combination of azelastine and fluticasone propionate statistically significantly more efficacious in reducing baseline total nasal symptom score by 5.7 as compared to azelastine (4.4; P < 0.001), fluticasone propionate (5.1; P < 0.001) and placebo (3.0; P < 0.001). The findings were supported by secondary assessments of scores of specific nasal and ocular symptoms. Pharmacokinetic studies have revealed no drug-drug interactions but a discrete increase in bioavailability of fluticasone propionate which was considered clinically unimportant. Further efficacy and quality-of-life studies of combination products of nasal antihistamines and corticosteroids are needed, especially, in primary care settings and in children before fixed combination treatment can be considered first line therapy in allergic rhinitis. Fixed combination treatment of azelastine and fluticasone propionate may offer additional benefit to selected populations of adolescents and adults with moderate-to-severe symptoms.

Topics: Administration, Intranasal; Adolescent; Adrenal Cortex Hormones; Adult; Androstadienes; Animals; Drug Combinations; Evidence-Based Medicine; Fluticasone; Histamine Antagonists; Humans; Mometasone Furoate; Patents as Topic; Phthalazines; Pregnadienediols; Pregnenediones; Randomized Controlled Trials as Topic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Treatment Outcome

Objectives To examine the association of industry payments for brand-name intranasal corticosteroids with prescribing patterns. Study Design Cross-sectional retrospective analysis. Setting Nationwide. Subjects and Methods We identified physicians prescribing intranasal corticosteroids to Medicare beneficiaries 2014-2015 and physicians receiving payment for the brand-name intranasal corticosteroids Dymista and Nasonex. Prescription and payment data were linked by physician, and we compared the proportion of prescriptions written for brand-name intranasal corticosteroids in industry-compensated vs non-industry-compensated physicians. We associated the number and dollar amount of industry payments with the relative frequency of brand-name prescriptions. Results In total, 164,587 physicians prescribing intranasal corticosteroids were identified, including 7937 (5%) otolaryngologists; 10,800 and 3886 physicians received industry compensation for Dymista and Nasonex, respectively. Physicians receiving industry payment for Dymista prescribed more Dymista as a proportion of total intranasal corticosteroid prescriptions than noncompensated physicians (3.1% [SD = 9.6%] vs 0.2% [SD = 2.5%], respectively, P < .001). Similar trends were seen for Nasonex (12.0% [SD = 16.8%] vs 4.8% [SD = 13.6%], P < .001). The number and dollar amount of payment were significantly correlated to the relative frequency of Dymista (ρ = 0.26, P < .001 and ρ = 0.20, P < .001, respectively) and Nasonex prescriptions (ρ = 0.09, P < .001 and ρ = 0.15, P < .001, respectively). For Dymista, this association was stronger in otolaryngologists than general practitioners ( P < .001). There was a stronger correlation between the percentage of prescriptions and the number and dollar amount of payments for Dymista than for Nasonex ( P = .014 and P < .001). Conclusions Industry compensation for brand-name intranasal corticosteroids is significantly associated with prescribing patterns. The magnitude of association may depend on physician specialty and the drug's time on the market.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Conflict of Interest; Cross-Sectional Studies; Drug Combinations; Drug Industry; Drug Utilization; Female; Fluticasone; Gift Giving; Humans; Interinstitutional Relations; Male; Mometasone Furoate; Phthalazines; Practice Patterns, Physicians'; Prescription Drugs; Retrospective Studies

We used light microscopy to search for local changes of the nasal mucosa associated with daily intranasal administration of mometasone furoate (MF), azelastine (AZ) or salmon calcitonin (SC).. Biopsies of the lower nasal turbinate were obtained from four groups of 8 individuals after 14 days of daily administration of a saline solution (control group) or of MF AZ and SC.. Small biopsies of the anterior portion of the lower nasal turbinate were collected with the help of a Hartmann forceps under direct visual inspection. The samples were processed for light microscopy and morphometric analysis. Inflammatory infiltration (neutrophils and lymphocytes) of the nasal mucosa was evaluated by a semiquantitative method. Unpaired t test and Bernoulli distribution were applied to evaluate statistical differences between data from the different groups of samples.. Samples of the turbinate mucosa of all of the drug-treated groups showed a moderate enhancement in infiltrating neutrophils when compared with the samples from the control group. Infiltration of lymphocytes in the turbinate chorion was significantly different from controls only in the MF and AZ-treated groups.. Intranasal treatment with MF AZ or SC does not cause significant changes in the general architecture of the nasal mucosa. A moderate inflammatory response of the turbinate mucosa, that was expressed by leukocyte infiltration of epithelium and chorion, was observed in all of the 3 drug-treated groups of patients after the 2-week course of intranasal deposition of MF, AZ or SC.

Topics: Administration, Intranasal; Adult; Aged; Anti-Allergic Agents; Anti-Inflammatory Agents; Biopsy; Calcitonin; Case-Control Studies; Drug Therapy, Combination; Female; Humans; Leukocyte Count; Leukocytes; Lymphocytes; Male; Microscopy, Polarization; Middle Aged; Mometasone Furoate; Nasal Mucosa; Neutrophils; Phthalazines; Pregnadienediols; Turbinates