H.William Kelly, PharmD Journal of Allergy and Clinical Immunology

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Presentation transcript:

Establishing a therapeutic index for the inhaled corticosteroids: Part I H.William Kelly, PharmD Journal of Allergy and Clinical Immunology Volume 102, Issue 4, Pages S36-S51 (October 1998) DOI: 10.1016/S0091-6749(98)70004-1 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Concentration-response curves of 3 different drugs in same pharmacologic class. Curves A and B , 2 drugs of equal efficacy but different potencies; curve C , drug with different efficacy and different potency. ED 50 , Median effective dose. Journal of Allergy and Clinical Immunology 1998 102, S36-S51DOI: (10.1016/S0091-6749(98)70004-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Systemic glucocorticoids: integrated pharmacodynamic model. AUC, Area under time-concentration curve; mRNA, messenger ribonucleic acid. Reproduced with permission from Jusko WJ. Corticosteroid pharmacodynamics: models for a broad array of receptor-mediated pharmacologic effects. J Clin Pharmacol 1990;30:303-10. Journal of Allergy and Clinical Immunology 1998 102, S36-S51DOI: (10.1016/S0091-6749(98)70004-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Systemic concentration of ICS is determined by oral bioavailability of swallowed fraction and by absorption from lung (inhaled fraction). Adapted with permission from Barnes PJ. Inhaled glucocorticoids for asthma. N Engl J Med 1995;332:868-75. Copyright © 1995, 1998 Massachusetts Medical Society. All rights reserved. Journal of Allergy and Clinical Immunology 1998 102, S36-S51DOI: (10.1016/S0091-6749(98)70004-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Difference with 95% confidence interval in mean improvement in morning PEF for FP and BDP. DH , Diskhaler; PEFR , peak expiratory flow rate. Reproduced from Barnes NC, Hallett C, Harris TAJ. Clinical experience with fluticasone propionate in asthma: a meta-analysis of efficacy and systemic activity compared with budesonide and beclomethasone dipropionate at half the microgram dose or less. Respir Med 1998;92:95-104, by permission of the publisher WB Saunders Company Limited, London. Journal of Allergy and Clinical Immunology 1998 102, S36-S51DOI: (10.1016/S0091-6749(98)70004-1) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 Difference with 95% CI in mean improvement in morning PEF for FP and BUD. PEFR, peak expiratory flow rate. Reproduced from Barnes NC, Hallett C, Harris TAJ. clinical experience with fluticasone propionate in asthma: a meta-analysis of efficacy and systemic activity compared with budesonide and beclomethasone dipropionate at half the microgram dose or less. Respir Med 1998;92:95-104, by permission of the publisher WB Saunders Company Limited, London. Journal of Allergy and Clinical Immunology 1998 102, S36-S51DOI: (10.1016/S0091-6749(98)70004-1) Copyright © 1998 Mosby, Inc. Terms and Conditions