Experts Reach Agreement on the Most Important Attributes of Combination Therapies for Asthma

By Mundipharma, PRNE
Sunday, December 5, 2010

The Agreement Will Provide Physicians With Much Needed Guidance for Choosing the Best Combination Therapy for Their Asthma Patients

CAMBRIDGE, England, December 6, 2010 - Data presented today at the World Allergy
Organization (WAO) International Conference have shown that: clinical
efficacy, safety, tolerability and speed of onset of a long-acting
Beta2-agonist (LABA), potency of an inhaled corticosteroid (ICS), and
flexibility of dosing are the most important attributes that influence an
expert's choice of a combination therapy to treat asthma.[1] This study,
undertaken under the auspices of the Global Allergy and Asthma European
Network (GA2LEN), used the Delphi process, a validated consensus-development
methodology that enables a group of experts to deal with a complex problem
through rounds of structured feedback.

"Given the lack of clear guidelines on selecting a specific ICS/LABA
therapy for asthma and the absence of conclusive evidence supporting
differences in clinical efficacy between the available combinations, this
consensus has the potential to provide physicians with better direction and
confidence when choosing the best option for their patients," commented
Professor David Price, Centre of Academic Primary Care, University of
, UK.

According to this study, the factors considered to be the most important
in the selection of a combination therapy as part of a stepped approach to
asthma management were ranked in the following order: flexibility of dosing
(88% agreement), long-term safety of the ICS and LABA (81%), clinical
efficacy (81%), LABA speed of onset (69%) and ICS potency (69%).[1],[2]

The findings from another study, presented at the WAO congress, support
the results from the Delphi process by indicating similar attributes of
combinations are important to physicians.[2] This attitudinal study, which
looked at the views of over 1,000 respiratory specialists and primary care
physicians, from 13 EU countries, in real-life practice identified the
symptom improvement (71%) and ICS potency (55%) as the most important
attributes, followed by improvement in fixed expiratory volume in 1 second
(FEV1; 50%), safety and tolerability (43%), speed of onset (42%), flexibility
of dosing (40%) and duration of action (37%).[2]

A further study, presented at the WAO conference, showed an increasing
trend in the prescribing of fixed combinations of an ICS and a LABA over the
period 2004-2009 whereas there was a slight decline in the prescribing of
ICSs alone or in free combination with a LABA over the same period.[3] The
study found that overall fluticasone was the most widely prescribed ICS in
Europe and the most widely prescribed ICS in fixed dose combination

All studies were supported by investment from Mundipharma.
"Mundipharma's support for these studies shows its commitment and investment
in research which will inform the development of better treatment strategies
in asthma and ultimately lead to reducing the individual and societal burden
of this debilitating condition," said Professor Dr. Karen Reimer, European
R&D Director at Mundipharma.

Notes to editors

About the studies presented at WAO

Combination therapy for asthma: Delphi process

GA2LEN undertook a Delphi process in order to reach agreement on which
factors are considered to be the most important to take into account when
choosing an ICS/LABA combination for asthma. Thirty-two experts from 9
European countries (Austria, Finland, France, Germany, Italy, Spain, Sweden,
Switzerland and the UK) were invited to participate. Three rounds of
structured feedback were considered in this Delphi process.

Pan-European attitudinal survey

Based on the responses of the Delphi consensus group, an attitudinal
questionnaire was developed, translated and pilot-tested in face-to-face
interviews. Computer-assisted web interviews were then conducted in 13
European countries. Of 1861 respondents, 1007 (54%) were eligible for
inclusion; 85% of eligible respondents were respiratory specialists and 15%
were primary physicians with a special interest in asthma, treating a mean of
59 asthma patients per month. Half (50%) of the patients with asthma were
being treated with ICS/LABA fixed combinations, 15% with ICS alone, 10% with
ICS/LABA free combinations, 10% with short-acting Beta2-agonists alone, other
therapy (10%) and 5% with LABAs alone.

Trends in prescribing inhaled corticosteroids alone and in combination
with long-acting Beta2-agonists in Europe in 2004-2009

The study gathered information on the retail prescribing of ICSs and
LABAs in 12 European countries (Austria, Denmark, Finland, France, Germany,
Ireland, Italy, Netherlands, Spain, Sweden, Switzerland and UK) between Q4
2004 and Q3 2009. For each formulation of each treatment, the number of
actuations was converted to the number of inhalers prescribed.

About Mundipharma

The Mundipharma / Napp / Norpharma independent associated companies, are
privately owned companies and joint ventures covering the world's
pharmaceutical markets. The companies worldwide are dedicated to bringing to
patients with severe and debilitating diseases the benefits of novel
treatment options in fields such as rheumatoid arthritis, moderate to severe
pain, haemato-oncology and respiratory disease.

For more information:


1. Price D, Bousquet J. Combination therapy for asthma:
results of a Delphi process. Abstract presented at World Allergy Organization
(WAO) International Conference in Dubai, 5-8 December 2010

2. Price D. Choosing combination therapy for asthma: results
of a pan-European attitudinal survey. Abstract presented at World Allergy
Organization (WAO) International Conference in Dubai, 5-8 December 2010

3. Price D. Trends in prescribing inhaled corticosteroids
alone and in combination with long-acting Beta2-agonists in Europe in
2004-2009. Abstract presented at World Allergy Organization (WAO)
International Conference in Dubai, 5-8 December 2010

For further information please contact: Bily Kuo, Bily.Kuo at, +44(0)1223-397-118, Wioletta Niznik, WNiznik at, +44(0)2070-670-202

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