Details

Autor(en) / Beteiligte

• Martin, Richard J., MD
• Szefler, Stanley J., MD
• King, Tonya S., PhD
• Kraft, Monica, MD
• Boushey, Homer A., MD
• Chinchilli, Vernon M., PhD
• Craig, Timothy J., DO
• DiMango, Emily A., MD
• Deykin, Aaron, MD
• Fahy, John V., MD
• Israel, Elliot, MD
• Lazarus, Stephen C., MD
• Lemanske, Robert F., MD
• Leone, Frank T., MD
• Pesola, Gene R., MD, MPH
• Peters, Stephen P., MD, PhD
• Sorkness, Christine A., PharmD
• Szwejbka, Lisa A., MSPH
• Wechsler, Michael E., MD

Titel

The Predicting Response to Inhaled Corticosteroid Efficacy (PRICE) trial

Ist Teil von

• Journal of allergy and clinical immunology, 2007, Vol.119 (1), p.73-80

Ort / Verlag

New York, NY: Mosby, Inc

Erscheinungsjahr

2007

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Although guidelines recommend anti-inflammatory therapy for persistent asthma, recent studies suggest that 25% to 35% of patients with asthma may not improve lung function with inhaled corticosteroids. Objective To evaluate potential biomarkers of predicting short-term (6-week) response to inhaled corticosteroid with subsequent evaluation of responders and nonresponders to asthma control over a longer interval (16 additional weeks). Methods Eighty-three subjects with asthma off steroid were enrolled in this multicenter study. Biomarkers and asthma characteristics were evaluated as predictors of inhaled corticosteroid response over a 6-week trial for changes in FEV1 and methacholine PC20 . After this, an additional 4-month trial evaluated asthma control. Results Although multiple baseline predictors had significant correlations with improvements for short-term inhaled steroid success, the only strong correlations ( r ≥ ± 0.6) were albuterol reversibility ( r = 0.83; P < .001), FEV1 /forced vital capacity ( r = −0.75; P < .001), and FEV1 % predicted ( r = −0.71; P  < .001). Dividing the subjects in the short-term inhaled steroid trial into responders (>5% FEV1 improvement) and nonresponders (≤5%) determined the longer-term need for steroids. For the nonresponders, asthma control remained unchanged whether inhaled corticosteroids were continued or were substituted with a placebo ( P = .99). The good short-term responders maintained asthma control longer-term only if maintained on inhaled steroids ( P = .007). Conclusion The short-term response to inhaled corticosteroids with regard to FEV1 improvement predicts long-term asthma control. Clinical implications The decision to use long-term inhaled steroids could be based on a short-term trial. Different therapeutic strategies would need to be established for nonresponders.