NEJM 5/17/07- I can’t help but wonder if this is a “welcome mat for new drug cocktail” study. Papi et al in the BEST study group publish a paper showing that using a steroid inhaler on an as-needed basis might be just as good as twice daily use.
The double-blind, double dummy design seems pretty robust, although makes the data a little complicated. In short – all subjects took a regular inhaler twice daily, plus an as-needed inhaler – the design just varied what was in the inhalers among groups. The most relevant comparison was – twice daily beclamethasone plus rescue albuterol (old skool method) versus twice daily placebo and rescue beclamethasone and albuterol combo.
It looks as if using a PRN steroid was just as good as the old twice daily method. The money graph seems to show that time to first exacerbation was the same in both groups and clearly better than albuterol rescue alone. Frankly the comparisons of PFTs and symptom scores got a little too crazy for me to handle but a cursory look seems to confirm the equivalence in most comparisons.
Any guesses as to what new combo inhaler we might be seeing soon? Check out the laundry list of financial disclosures at the end – Im sure one of those companies is planning to cash in on this one.