November 13, 2009 (San Diego, California) — A aggregate of azelastine hydrochloride and fluticasone propionate nasal sprays administered in a distinct commitment accessory can decidedly advance both nasal and ocular affection in patients with abstinent to astringent melancholia allergic rhinitis (SAR), according to a new randomized placebo-controlled study.
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Results were presented actuality at the American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Scientific Meeting in a belvedere affair by Paul Ratner, MD, allergist/immunologist and architect and administrator of Sylvana Research, of San Antonio, Texas, a analysis adeptness for investigational medications.
"This abstraction is important because if you attending at statistics and at bodies with accretion severity of their allergies, you see an accretion bulk of ocular symptoms," said Dr. Ratner in an account with Medscape Allergy and Immunology.
He appear that about 75% of the best astringent SAR patients accuse of acquisitive eyes and about two thirds of them accuse of adulterated eyes. "It's a actual accepted evidence circuitous that you see forth with the nasal bottleneck and aqueous adenoids and added things that appear with allergies."
Growing Absorption in Aggregate Treatment
"Recently, there's been a lot of absorption in attractive at combinations of nasal antihistamines and nasal corticosteroids, with antecedent studies assuming that the aggregate is added able statistically than the distinct entities," said Dr. Ratner. "In this study, we capital to attending accurately at the ocular furnishings from analysis with this combination."
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His investigational aggregation enrolled 610 patients with ocular affection from SAR during the 2007/08 Texas Mountain Cedar season. The patients were randomized to 1 of 4 groups accepting 1 aerosol per nostril alert daily: azelastine alone, fluticasone alone, azelastine additional fluticasone, and placebo.
The primary end point was efficacy, authentic as a change from baseline in the absolute nasal evidence account (TNSS) for nasal congestion, sneezing, acquisitive nose, and aqueous nose.
The accessory end point was the aftereffect of azelastine additional fluticasone on the absolute ocular evidence account (TOSS) for acquisitive eyes, adulterated eyes, and redness.
Nasal and Ocular Affection Improved
Results showed that improvements on TNSS were statistically cogent for the patients advised with the aggregate aerosol (31.3%), compared with those advised with fluticasone abandoned (20.8%), azelastine abandoned (16.3%), or placebo (9.0%; P < .001).
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There was additionally a statistically cogent advance in TOSS for those advised with the aggregate aerosol (26.4%), compared with those advised with azelastine abandoned (19.3%), fluticasone abandoned (16.6%), or placebo (8.9%; P < .001).
The alone adverse contest appear by added than 2% of those advised with the aggregate aerosol were absinthian aftertaste (7.2%), epistaxis (3.9%), and cephalalgia (2.6%).
"There are 2 key credibility to this study," said Dr. Ratner. "The aboriginal is that the aggregate analysis with nasal antihistamines and nasal steroids is absolutely animadversion out to be added able than analysis with the alone components. Second, in accession to alleviative the nasal affection that you would expect, you're additionally accepting the added account of accepting abatement of the ocular symptoms."
He added that "if you attending at the way allergists are practicing now, I'd say that they're application both drugs in aggregate in 30% to 40% of their patients. The advantage and adeptness to accept a artefact that would reflect that accumulated analysis in a distinct inhaler is article I anticipate would absolutely enhance the analysis of patients."
Treat the Eyes and the Nose
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"I anticipate the take-away from this abstraction is to bethink that the adenoids and the eyes go duke and hand," said ACAAI abstruse analysis board armchair John J. Oppenheimer, MD, accessory analytic assistant of anesthetic at New Jersey Medical School in Newark.
"When we anticipate about allergic rhinitis, we balloon that the eyes appear along. There accept been a lot of absolutely affected studies assuming that the ocular complaints in these patients are absolutely quality-of-life diminishing. So what this abstraction reinforces is that polypharmacy, application an antihistamine acquaintance as able-bodied as a nasal steroid, may be a added able modality in alleviative this ocular complaint and the nasal symptoms," said Dr. Oppenheimer, who was not complex with this study.
He added: "I anticipate added analysis is bare to advice us try to aggravate out what the best important genitalia are. Patients with [SAR] absolutely ache and every year they apperceive they're activity to be bedevilled by this illness. I anticipate actuality able to accommodate bigger interventions for them is absolutely activity to be my achievement for the future. It's aloof absolutely important for us to do a bigger job."
This abstraction was adjourned by Meda Pharmaceuticals. Dr. Ratner has appear no accordant banking relationships. Dr. Oppenheimer letters actuality a adviser and accomplishing analysis for Glaxo, AstraZeneca, Schering, Merck, Novartis, and Genentech.
American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Scientific Meeting: Abstruse 26. Presented November 8, 2009.
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