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Impact of Allergic Rhinitis (AR) Symptoms on Quality of Life lModerate-to-severe allergic rhinitis symptoms are associated with –Fatigue and daytime somnolence.

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Presentation on theme: "Impact of Allergic Rhinitis (AR) Symptoms on Quality of Life lModerate-to-severe allergic rhinitis symptoms are associated with –Fatigue and daytime somnolence."— Presentation transcript:

1 Impact of Allergic Rhinitis (AR) Symptoms on Quality of Life lModerate-to-severe allergic rhinitis symptoms are associated with –Fatigue and daytime somnolence 1–3 –Daily activity impairment 4,5 –Reduced work productivity 4–8 –Disturbed cognitive functions 9 –Reduced learning abilities 10,11 –Adverse effects on adolescent behaviour 6 1. Borres MP et al. Ann Allergy Asthma Immunol 1997; 78: 29–34; 2. Craig TJ et al. J Allergy Clin Immunol 2005; 116: 1264–1266; 3. Young T et al. J Allergy Clin Immunol 1997; 99: S757–S762; 4. Reilly MC et al. Clin Drug Invest 1996; 11: 278–288; 5. Tanner et al. Am J Manag Care 1999; 5(Suppl 4): S235–S247; 6. Juniper EF et al. J Allergy Clin Immunol 1994; 93: 413–423; 7. Corey JP et al. Otolaryngol Head Neck Surg 2000; 122: 681–685; 8. Blanc PD et al. J Clin Epidemiol 2001; 54: 610–618; 9. Marshall PS and Colon EA. Ann Allergy 1993; 71: 251–258; 10. Vuurman EF et al. Ann Allergy Asthma Immunol 1996; 76: 247–252; 11. Walker S et al. Eur Respir J 2005; 26(Suppl 49): 134s.

2 Epidemiology Of Allergic Rhinitis lAllergic rhinitis was reported the second most prevalent chronic condition in the United States in 1994 lAffects 40 to 50 million people lIncidence highest in people ages years lPrevalence of Allergic Rhinitis is Increasing

3 Despite Available Treatment Nasal Symptom Burden Remains High During an allergy season AR symptom sufferers have a large nasal symptom burden despite the availability of over-the-counter and prescription treatments Nathan RA et al. AAAAI 2006.

4 Hay Fever Symptoms Have a Significant Impact on Exam Performance lA case-control study in UK students sitting national exams in three subjects (May–June 2004) l36% (673/1862) dropped at least one grade in at least one subject compared with winter exam Cases (dropped at least one grade) (n=673) Controls (n=1189) Mean diff (95% Cl) Hay fever symptoms, n (%) 389 (59.9%) 623 (53.9%) 5.4%* ( ) *P=0.001 Walker S et al. Eur Respir J 2005; 26(Suppl 49): 134s.

5 Očesni simptomi so pomembni pri zdravljenju alergijskega rinitisa 71% bolnikov trpi zaradi očesnih simptomov 50% jemlje več zdravil za AR Majority of these still not satisfied with treatment Anti-histamines are not effective enough on nasal symptoms Current INSs do not work on eye symptoms

6 Systemic availability of INS Brand PL. Eur Resp J 2001;287–94. Daley-Yates PT, Richards DH. Clin Ther 2004;26:1905–19. Influenced by: lINS bioavailability lDegree of first-pass inactivation in liver Systemic availability via swallowed portion Systemic availability via lungs

7 Nazalno okularni živčni refleks 1. FF ima visoko afiniteto do glukokortikoidnega receptorja To lahko povzroči boljšo inhibicijo nasalno okularnega refleksnega mehanizma 3. Sproščanje mediatorjev, ki povzročajo okularne simptome je zmanjšano

8 Fluticasone furoate: glukokortikoid z večjo afiniteto do receptorjev Valotis A, Högger P. EAACI 2006, Abstract 780. Fluticasone furoate Mometasone furoate Fluticasone propionate Beclometha- sone-17- monopropionate Ciclesonide active principle Budesonide Dexamethasone Relative receptor affinity (RRA)

9 Fluticasone furoate: a novel molecule F O O O F HO F Fluticasone furoate Fluticasone propionate (FP)‏ O O O F HO CO O 17 Mometasone furoate (MF)‏ HO CH 2 CI O O O O CI SCH 2 F COCH 2 CH 3 Fluticasone furoate is a different active chemical entity from fluticasone propionate or mometasone furoate O Biggadike K et al. EAACI 2006, Abstract 783. Biggadike K et al. J Med Chem 2008;51:3349–52.

10 Fluticasone furoate tissue retention in human lung epithelial cells 30 h Fluticasone furoate ( M) Fluticasone propionate ( M) 4 h Adcock I, Ito K, data on file. Valotis A, Högger P. Respir Res 2007;8:54. High retention of fluticasone furoate in tissues enhances its duration of action Fluticasone furoate remains bound to glucocorticoid receptor at its cellular site of action for >24 hours

11 Fluticasone furoate shows greatest in vitro cell retention Epithelial cell association after 6 hours (% of total recovered) FFFPMFBudesonideFlunisolideTriamcinolone acetonide Salter M et al. Am J Physiol Lung Cell Mol Physiol 2007;293:L660–L667.

12 Fluticasone furoate shows enhanced affinity for the glucocorticoid receptor Valotis A, Högger P. Respir Res 2007;8:54. Salter M et al. Am J Physiol Lung Cell Mol Physiol 2007;293:L660–L Fluticasone furoate Fluticasone propionate Mometasone furoate Ciclesonide active principle Relative Receptor Affinity (RRA) Dexamethasone Budesonide FF has the highest GR affinity compared with other currently available INS

13 Fluticasone furoate – nudi boljšo zaščito pred poškodbo celic Salter M et al. Am J Physiol Lung Cell Mol Physiol 2007;doi: /ajplung

14 Fluticasone furoate: highly selective for GR Salter M et al. Am J Physiol Lung Cell Mol Physiol 2007;293:L660–L Fluticasone propionate Fluticasone furoate Human steroid hormone receptor selectivity Mometasone furoate Ciclesonide active principle Budesonide Mineralocorticoid receptor Progesterone receptor-b FF has greater selectivity for the GR than other INS Lower selectivity for GRGreater selectivity for GR 1:1 800:1

15 Fluticasone furoate: protection against mechanically induced inflammatory damage Wound area (% of control) Glucocorticoid concentration (nM) Salter M et al. Am J Physiol Lung Cell Mol Physiol 2007;293:L660–L667. Fluticasone furoate Fluticasone propionate Mometasone furoate Budesonide

16 Fluticasone furoate: low bioavailability Bryson HM, Faulds D. Drugs 1992;43:760–75. Daley-Yates PT, Baker RC. Br J Clin Pharmacol 2001;51:103–5. Daley-Yates PT et al. Eur J Clin Pharmacol 2004;60:265–8. Allen A et al. Clin Ther 2007;29:1415–20. Bioavailability of currently used INS

17 Nazalno okularni živčni refleks 1. FF ima visoko afiniteto do glukokortikoidnega receptorja To lahko povzroči boljšo inhibicijo nasalno okularnega refleksnega mehanizma 3. Sproščanje mediatorjev, ki povzročajo okularne simptome je zmanjšano

18 Delivery system is designed to meet the needs of patients Easy to use device Patient-friendly spray No taste or smell Little or no drip down the throat (half the spray volume of other intranasal steroids Gentle spray, a consistent amount each time Viewing window See how much is left Easy to grip with side actuation Comfortable for patients Nozzle is short and ergonomically designed


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