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Sample Topic: Asthma

Asthma : Last revised in December 2013


Evidence on Symbicort Smart® for maintenance and reliever therapy for asthma management

  • Symbicort SMART® compared with ICS + long-acting beta2-agonist (adults)
    • One Cochrane systematic review (search date September 2008, five randomized open controlled trials) found that Symbicort SMART® was no different to current best practice (ICS plus long-acting beta2-agonist) [Cates and Lasserson, 2009].
      • Exacerbations of asthma requiring treatment with oral corticosteroids: OR 0.83, 95% CI 0.66 to 1.03 (n = 4,470).
      • Exacerbations requiring hospital admissions: OR 0.59, 95% CI 0.24 to 1.45 (n = 5378).
      • There was no difference in the rate of fatal or non-fatal adverse events (data from three studies). The event rates were too low to rule out a clinically significant increase or decrease in adverse events.
      • Another four studies comparing Symbicort SMART® with current best practice are due for completion soon, and the results from a further 4600 participants are awaited.
  • Symbicort SMART® compared with ICS alone (adults and adolescents)
    • The same Cochrane systematic review (search date September 2008, three randomized, double-blind controlled trials, one randomized open controlled trial) found that Symbicort SMART® was no different to ICS alone for exacerbations needing hospital admission, but there were fewer exacerbations requiring oral corticosteroids [Cates and Lasserson, 2009]. One study compared Symbicort SMART® to the same dose of ICS. Three studies compared Symbicort SMART ® to increased dose ICS. Patients were withdrawn from their long-acting beta2-agonist in the ICS arms. The authors argue that this could have led to an increase in early exacerbations in patients taking ICS because an increase in the ICS dose would be expected to take longer to work than the long-acting beta2-agonist component in Symbicort®.
      • Exacerbations of asthma requiring treatment with oral corticosteroids: OR 0.54, 95% CI 0.45 to 0.64 (n = 4280).
      • Exacerbations requiring hospital admission: OR 0.56, 95% CI 0.28 to 1.09 (n = 4209).
      • There was no difference in the rate of fatal or non-fatal adverse events (data from three studies). The event rates were too low to rule out a clinically significant increase or decrease in adverse events.