Extrafine HFA-beclomethasone dipropionate versus budesonide for asthma: a meta-analysis

The small-particle inhaled corticosteroid might be a new available way to treat uncontrolled asthma. To evaluate the efficacy and safety of extrafine hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP) versus budesonide (BUD) in patients with asthma, a meta-analysis was performed. A systematic search was made of PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Clinicaltrials.gov and Ovid, and a hand search of leading respiratory journals. Randomised controlled trials (RCTs) on treatment of asthma for 4 or more weeks with extrafine HFA-BDP, compared with BUD, were reviewed. Five studies involving 949 asthmatic patients met the inclusion criteria. There was no significant difference in FEV1 (SMD=-0.03L, 95% CI -0.15 to 0.10L, I(2)=0%, P=0.70), morning PEF (WMD=0.88 L/min, 95% CI -5.96 to 7.72 L/min, I(2)=0%, P=0.80), evening PEF (WMD=6.32 L/min, 95% CI -1.17 to 13.81 L/min, I(2)=33%, P=0.10) and use of rescue medication (WMD=-0.13, 95% CI -0.31 to 0.06, I(2)=41%, P=0.18) between extrafine HFA-BDP at half of the daily dose and BUD group. Individual studies reported no significant differences in asthma exacerbations and 7-point Asthma Control Questionnaire score (ACQ-7). There were no significant difference in total number of adverse events (OR=1.04, 95% CI 0.78 to 1.38, I(2)=0%, P=0.81) between the two groups. Our meta-analysis demonstrated that extrafine HFA-BDP at half of daily dose is equivalent to BUD in improving lung function and use of rescue medication, without increasing adverse events in patients with asthma. Long-term trials are required to assess the efficacy and safety of extrafine HFA-BDP.