Six doses of fluticasone propionate ranging from 16 mcg to 434 mcg (expressed as metered doses) administered twice daily via MDPI were evaluated in 2 randomized, double-blind, placebo-controlled 12 week trials in patients with asthma. 

  * Trial 201 was conducted in patients whose asthma was uncontrolled at baseline and had been treated by short-acting beta2-agonist alone or in combination with non-corticosteroid asthma medication. Low dose inhaled corticosteroids (ICS)-treated patients may have been included after a minimum of 2 weeks washout. This trial contained an open-label active comparator fluticasone propionate inhalation powder 100 mcg administered twice daily. 

  * Trial 202 was conducted in patients whose asthma was uncontrolled at baseline and had been treated with high dose ICS with or without a LABA. This study contained an open-label active comparator fluticasone propionate inhalation powder 250 mcg twice daily. 

The trials were dose-ranging trials of fluticasone propionate MDPI not designed to provide comparative effectiveness data and should not be interpreted as evidence of superiority/inferiority to fluticasone propionate inhalation powder. The metered doses for fluticasone MDPI (16, 28, 59, 118, 225, 434 mcg) used in Trial 201 and Trial 202 (see Figure 1) are slightly different from the metered doses for the comparator products (fluticasone inhalation powder) and the Phase 3 investigational products which are the basis of the proposed commercial labeled claim (55, 113, 232 mcg for fluticasone). The changes in doses between Phase 2 and 3 resulted from optimization of the manufacturing process. 




Figure 1: Baseline Adjusted Least Square Mean Change in Trough Morning FEV1 (L) over 12 weeks (FAS)a

FAS = full analysis set; aTrials were not designed to provide comparative effectiveness data and should not be interpreted as superiority/inferiority to fluticasone propionate inhalation powder

The efficacy and safety of four doses of salmeterol xinafoate were evaluated in a double blind, 6-period crossover study compared with single dose fluticasone propionate MDPI and open label fluticasone propionate/salmeterol 100 mcg/50 mcg dry powder inhaler (DPI) as comparator in patients with persistent asthma. The trials were dose-ranging trials of the salmeterol component of Fluticasone Propionate/Salmeterol MDPI and not designed to provide comparative effectiveness data and should not be interpreted as evidence of superiority/inferiority to fluticasone propionate/salmeterol inhalation powder. The salmeterol doses studied were 6.8 mcg, 13.2 mcg, 26.8 mcg and 57.4 mcg in combination with fluticasone propionate 118 mcg delivered by MDPI (expressed as metered dose). The metered doses for salmeterol (6.8, 13.2, 26.8, 57.4 mcg) used in this study are slightly different from the metered doses for the comparator products (fluticasone/salmeterol inhalation powder) and the Phase 3 investigational products which are the basis of the proposed commercial labeled claim (55, 113, 232 mcg for fluticasone and 14 mcg for salmeterol). The phase 3 and commercial products were optimized to better match the strengths to the comparators. Plasma for pharmacokinetic characterization was obtained at each dosing period. Fluticasone propionate/salmeterol xinafoate MDPI 118 mcg/13.2 mcg had similar clinical efficacy with lower systemic exposure when compared to the 50 mcg of salmeterol in fluticasone propionate/salmeterol 100 mcg/50 mcg dry powder inhaler (Figure 2).

Figure 2: Mean Baseline Adjusted FEV1 (mL) over 12 Hours (FAS)a

FS MDPI = fluticasone propionate/salmeterol multidose dry powder inhaler; Fp MDPI = fluticasone propionate multidose dry powder inhaler; FS DPI = fluticasone propionate/salmeterol dry powder inhaler; FAS = full analysis set; FEV1 = forced expiratory volume in 1 second; aTrial was not designed to provide comparative effectiveness data and should not be interpreted as superiority/inferiority to fluticasone propionate/salmeterol inhalation powder.