Introduction

Intranasal corticosteroids are first-line treatment for moderate-to-severe seasonal allergic rhinitis (AR). Fluticasone furoate and fluticasone propionate are approved the for the treatment of symptoms of seasonal and perennial AR.

Aim

To compare preferences for fluticasone furoate and fluticasone propionate nasal sprays after 1 week of treatment in patients with symptomatic seasonal AR.

Patient Profile

Adults with a clinical history of seasonal AR and nasal symptoms during each of the 2 previous fall allergy seasons were eligible if they had a positive skin test result to fall allergens appropriate to their region and had exposure to fall seasonal allergens during the study period.

Methods

• Randomized, double-blind, placebo-controlled, multidose study

  

• First 7-day treatment period was followed by a 7-day washout period then a second 7-day treatment period consisting of alternate treatment in the randomized treatment sequence. (Group 1 → Group 2, Group 2 → Group 1, Group 3 → Group 4, Group 4 → Group 3)
• Second treatment period was followed by telephone call within 3-5 days to assess adverse events
• ·n= 143 completed treatment in active treatment sequences (Group 1 and 2)
• ·n= 156 completed treatment in placebo treatment sequences (Group 3 and 4)

Study endpoints

• Efficacy endpoint: Sum of 4 nasal symptom ratings defined as reflective total nasal symptom score (rTNSS). Patient’s symptoms assessed during a 12-hour period and twice daily, before the morning treatment and 12 hours after treatment
• Patient preference endpoints for either fluticasone furoate or fluticasone propionate at the end of second crossover period based on

• Primary: Product scent or odor
• Secondary: Product leaking out of the nose and down the throat, ease of use, and gentleness of mist. Other preference endpoints were delivery of the same amount of medication with each use, comfort of the nose tip, spray delivery method (ie, top-down vs side-actuation), and aftertaste

Results

Efficacy

• Mean baseline daytime rTNSSs, nighttime rTNSSs, and daily rTNSSs were similar between treatment groups
• Fluticasone furoate (P <.001) and fluticasone propionate (P < .01) once daily for 1 week each significantly reduced daily rTNSS compared with its respective vehicle placebo nasal spray
• Both were statistically significantly more efficacious than their respective vehicle placebo sprays in improving daytime rTNSS and nighttime rTNSS during 1 week

Patient preference

Fluticasone furoate was significantly preferred over fluticasone propionate for its scent, lack of leakage, gentleness, and minimal aftertaste.

• Scent and Leakage:
  • Patients exceedingly preferred fluticasone furoate over fluticasone propionate in terms of scent (58% vs. 27%, P <.001) and medication leakage (59% vs. 21%, P <.001)
  • 15% had no preference for scent and 31% had no preference for leakage

• Other attributes:
  • Fluticasone furoate was also rated higher (P <.001) for:
    • Gentleness of mist (57% vs. 26%)
    • Less aftertaste (60% vs. 18%)
  • No significant differences were found in preferences for: Ease of use, consistency of medication delivery, delivery method, device comfort
  • 17-31% had no preference for these attributes

  Tolerability

  The proportions of patients with any adverse event were similar among treatments. Most events were described as mild or moderate.

  Conclusion

• Both fluticasone furoate and fluticasone propionate significantly improved symptoms in adult patients with seasonal AR
• Most patients preferred the sensory attributes of fluticasone furoate to those of fluticasone propionate after 1 week of treatment.

Reference

Ann Allergy Asthma Immunol. 2010 Apr;104(4):331-8.