Latest research on Fluticasone

Fluticasone propionate, a medium-potency synthetic corticosteroid, is used topically to relieve inflammatory and pruritic symptoms of dermatoses and psoriasis, intranasally to manage symptoms of allergic and non-allergic rhinitis, and orally for the treatment of asthma. Fluticasone proprionate is marketed under several different brand names such as Flonase®. Fluticasone propionate is also available as a combination product of azelastine hydrochloride and fluticasone propionate called Dymista™. Dymista™ is indicated in patients over 12 years old for symptomatic relief of seasonal allergic rhinitis.

Fluticasone side effects

In the Netherlands, the prevalence of Beclometasone prescribing during pregnancy was almost double the prevalence observed before and after pregnancy, with the increase coinciding with a reduction in the prescribing of Fluticasone and other ICS in a fixed-dose combination with a LABA. [source, 2016]
A randomized trial conducted in Canada in subjects with moderate to severe COPD showed a decreased exacerbation rate in subjects receiving Fluticasone as part of a triple therapy regimen of tiotropium/Fluticasone/salmeterol compared with those receiving tiotropium alone or tiotropium/salmeterol [38]. [source, 2016]
Fluticasone propionate (FP), either alone or in association with other bronchodilators, is one of the most commonly prescribed ICSs because it is considered effective and well tolerated [1]. [source, 2016]
Those study authors found an increased risk of pneumonia with Fluticasone use versus placebo and for any Fluticasone/LABA combination versus LABA alone. [source, 2015]
Their results further showed a decrease in sodium sulfite-induced IL-8 production following treatment with Fluticasone, Salmeterol, and Montelukast,52 each of which is known to have differing mechanisms of action (steroid, β-agonist, and leukotriene modifier, respectively). [source, 2015]
Several studies could not reveal systemic side effects [1356], [1357], [1358], even in cases of significantly higher Cortisone doses (3 mg Fluticasone 2x per day for 6 weeks, [1359]). [source, 2015]
At present, it remains uncertain to what extent increased risk of pneumonia is associated with other ICS or combinations of ICS and long-acting β2-agonists, but a combination of inhaled Fluticasone propionate and Salmeterol may cause a higher risk 107–110. [source, 2015]
A tiotropium run-in also avoids concerns as to an ICS withdrawal-induced increase in exacerbations in the formoterol arm23 – although Lapperre et al showed no evidence of an increase in proinflammatory markers or exaggerated clinical deterioration in COPD patients treated for 6 months with inhaled Fluticasone followed by ICS withdrawal. [source, 2015]
The Investigating New Standards for Prophylaxis In Reduction of Exacerbations (INSPIRE) study observed an increase in mortality in the tiotropium (HandiHaler®) group compared with the Salmeterol and Fluticasone groups. [source, 2015]
At the GP-level, some GPs perceived the study to be too intellectual/confronting for patients: “I feel your program is too intellectual for ordinary patients who find instructions too difficult and give up & avoid anything too confronting and being shown up by other parties is unhelpful”, or expressed confusion about recruitment information: “When invited to participate I agreed because I had patients on Symbicort and Seretide. [source, 2015]