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Monday, February 22, 2016

Comparison: Fluticasone Furoate VS Mometasone

Availability
  • Nasonex® (mometasone furoate) 50 micrograms/ spray
  • Avamys®(fluticasone furoate) 27.5 micrograms / spray
Recommendations:
  • HMMC recommend choices of intranasal corticosteroids (INS) for allergic rhinitis should be in accordance with previous HMMC recommendations:
  • 1st Line: Beclometasone
  • 2nd Line: Budesonide – prescribe as Rhinocort Aqua® (cheaper than generic)
  • 3rd Line: Fluticasone propionate – prescribe as Nasofan® OR Mometasone (Nasonex®)
Comparison
  • It may be considered as an option when an intranasal corticosteroid is indicated only for patients with an inability to use standard nasal sprays but able to use the Avamys® device.
Evidence of Clinical Effectiveness:
  • Evidence for fluticasone furoate vs intranasal corticosteroid comparators is limited. Limited unpublished studies have shown comparable efficacy to fluticasone propionate (FP) and mometasone furoate.
  • Manufacturer sponsored review of placebo controlled studies assessing ocular efficacy of INS in SAR reported only FF as demonstrating a consistent positive effect on ocular outcomes. 
  • Although statistically significant, there is some uncertainty regarding the clinical significance of differences seen for ocular symptom improvement between FF & placebo in studies in SAR.
  • Studies in PAR have not demonstrated consistent benefits for FF vs placebo on ocular symptoms.
  • Claims of greater receptor affinity or selectivity for FF have yet to be shown to make a real difference in clinical use.
  • In perennial allergic rhinitis, one open-label, active-controlled study in adults showed there to be no significant difference in fluticasone furoate and mometasone furoate reducing the Total Nasal Symptom Score.
References:
  1. HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC)
  2. New Medicines Committee Briefing, Fluticasone furoate (Avamys®) nasal spray suspension.January 2014
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3911800/ 
  4. http://www.pediatr-neonatol.com/article/S1875-9572%2813%2900008-9/abstract

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