ASK DIS: Comparison: Fluticasone Furoate VS Mometasone

Availability

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 Limited unpublished studies have shown comparable efficacy to fluticasone propionate (FP) and mometasone furoate.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:

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC)
New Medicines Committee Briefing, Fluticasone furoate (Avamys®) nasal spray suspension.January 2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3911800/
http://www.pediatr-neonatol.com/article/S1875-9572%2813%2900008-9/abstract

ASK DIS