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Comparisonof Clinical Efficacy Between Morning and Evening Dosing of Once-Daily Inhaled Corticosteroids in Patients with Asthma: A Systemic Review and Meta-Analysis
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A4833 - Comparisonof Clinical Efficacy Between Morning and Evening Dosing of Once-Daily Inhaled Corticosteroids in Patients with Asthma: A Systemic Review and Meta-Analysis
Author Block: G. Seong1, J. Lee1, J. Song2; 1Internal medicine, Jeju national university hospital, Jeju, Korea, Republic of, 2Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of.
RATIONALE: Once-daily inhaled corticosteroids (ICS) are widely used as first-line therapy in patients with asthma. Several randomized controlled trials (RCTs) for dosing time of once-daily ICS in patients with asthma have been published. However, it is unclear whether the efficacy of once-daily ICS between morning and evening dosing is different or not. The aim of this study was to investigate the treatment differences in clinical efficacy between ICS administered once-daily in the morning and evening in patients with asthma based on a systematic review of clinical trial data. METHODS: MEDLINE, EMBASE, and Cochrane Central Register were searched for relevant clinical trials to review. The primary outcome was lung function such as the changes in forced expiratory volume in 1 second (FEV1) and in peak expiratory flow (morning, evening, and daily). We also assessed the changes of using of rescue medicines and the incidence of adverse events.RESULTS: A total of eight RCTs involving 1,234 patients were analyzed. The total number of once-daily ICS administered morning and evening was 628 and 606, respectively. Pooled estimates showed that ICS administered once-daily in the evening resulted in mild improvements in trough FEV1 at endpoint than morning dosing (mean difference [MD], 0.05L; 95% CI 0.01 to 0.09; P = 0.026; I2 = 22.5%). Compared with morning dosing, once-daily ICS administered evening produced statistically significant increases in morning PEF at endpoint (MD, 13.92 L/min; 95% CI 5.77 to 22.06; I2 = 13%). Whereas, in evening PEF and mean daily PEF at endpoint, there appeared to be no difference between morning and evening dosing (MD, 6.06 L/min; 95% CI -1.81 to 13.93; I2 = 0% and mean difference, 7.53 L/min; 95% CI -0.29 to 15.35; I2 = 0%, respectively). And the number of the change of using rescue medicine at endpoint and the incidence of adverse events in once-daily ICS was not significant different between two groups (MD, -0.31; 95% CI -0.66 to 0.55; I2 = 0% and 34.8% vs. 31.9%; RR, 0.92; 95% CI 0.76 to 1.11; I2=0%, respectively).CONCLUSION: ICS administered once-daily in the evening seemed to provide some benefits in lung function of trough FEV1 and morning PEF at endpoint in asthma. But, because of methodological limitations, further large-scale RCTs for dosing time of once-daily ICS are needed.
Author Block: G. Seong1, J. Lee1, J. Song2; 1Internal medicine, Jeju national university hospital, Jeju, Korea, Republic of, 2Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of.
RATIONALE: Once-daily inhaled corticosteroids (ICS) are widely used as first-line therapy in patients with asthma. Several randomized controlled trials (RCTs) for dosing time of once-daily ICS in patients with asthma have been published. However, it is unclear whether the efficacy of once-daily ICS between morning and evening dosing is different or not. The aim of this study was to investigate the treatment differences in clinical efficacy between ICS administered once-daily in the morning and evening in patients with asthma based on a systematic review of clinical trial data. METHODS: MEDLINE, EMBASE, and Cochrane Central Register were searched for relevant clinical trials to review. The primary outcome was lung function such as the changes in forced expiratory volume in 1 second (FEV1) and in peak expiratory flow (morning, evening, and daily). We also assessed the changes of using of rescue medicines and the incidence of adverse events.RESULTS: A total of eight RCTs involving 1,234 patients were analyzed. The total number of once-daily ICS administered morning and evening was 628 and 606, respectively. Pooled estimates showed that ICS administered once-daily in the evening resulted in mild improvements in trough FEV1 at endpoint than morning dosing (mean difference [MD], 0.05L; 95% CI 0.01 to 0.09; P = 0.026; I2 = 22.5%). Compared with morning dosing, once-daily ICS administered evening produced statistically significant increases in morning PEF at endpoint (MD, 13.92 L/min; 95% CI 5.77 to 22.06; I2 = 13%). Whereas, in evening PEF and mean daily PEF at endpoint, there appeared to be no difference between morning and evening dosing (MD, 6.06 L/min; 95% CI -1.81 to 13.93; I2 = 0% and mean difference, 7.53 L/min; 95% CI -0.29 to 15.35; I2 = 0%, respectively). And the number of the change of using rescue medicine at endpoint and the incidence of adverse events in once-daily ICS was not significant different between two groups (MD, -0.31; 95% CI -0.66 to 0.55; I2 = 0% and 34.8% vs. 31.9%; RR, 0.92; 95% CI 0.76 to 1.11; I2=0%, respectively).CONCLUSION: ICS administered once-daily in the evening seemed to provide some benefits in lung function of trough FEV1 and morning PEF at endpoint in asthma. But, because of methodological limitations, further large-scale RCTs for dosing time of once-daily ICS are needed.
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