Letter to the Editor
Discrepancies between GEMA And GINA in the classification of inhaled corticosteroids
Discrepancias en la clasificación de los glucocorticoides inhalados entre GEMA y GINA
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In GINA,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> this dose is listed as low, while in GEMA,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> it is defined as medium. Despite the fact that fluticasone furoate is not marketed in Spain, and is only available in combination with vilanterol, this discrepancy needs clarification.</p><p id="par0015" class="elsevierStylePara elsevierViewall">An ICS dose should ideally be classified in these tables on the basis of therapeutic potency and safety.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Traditionally, ICS have shown a linear relationship between efficacy and safety, so they could be compared in terms of dose-equivalence.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Fluticasone furoate can be considered a new-generation ICS, designed to achieve greater receptor affinity, in such a way that the linear relationship between efficacy and safety changes to a curve, demonstrated by the relationship between the therapeutic index (daily dose of ICS that would result in 20% cortisol suppression for each daily clinical dose of ICS) and ICS receptor occupancy, allowing it to achieve therapeutic effects similar to traditional therapies, but at a lower concentration.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Safety can be estimated by calculating the dose that would result in 20% cortisol suppression. For this drug, according to pharmacokinetic/pharmacodynamic models, that dose would be 580<span class="elsevierStyleHsp" style=""></span>μg once daily,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> more than 5 times the therapeutic dose. Another finding supporting safety is that the suppression of the hypothalamic-pituitary-adrenal axis caused by fluticasone furoate is no different to that of placebo.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, data on potency and safety allow us to predict that a dose of 100<span class="elsevierStyleHsp" style=""></span>μg fluticasone furoate will behave in the same way as a low dose of ICS, and the discrepancy in the GINA<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and GEMA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> classifications should be corrected by including in the latter a daily dose of 100<span class="elsevierStyleHsp" style=""></span>μg fluticasone furoate as a low dose ICS.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-22" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Entrenas Costa LM, Entrenas Castillo M. Discrepancias en la clasificación de los glucocorticoides inhalados entre GEMA y GINA. Arch Bronconeumol. 2019;55:667–667.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pocket guide for asthma management and prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Global Initiative for Asthma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "GEMA4.4. Guía española para el manejo del asma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Comité Ejecutivo de la GEMA" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2019" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled corticosteroids: potency, dose equivalence and therapeutic index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.T. Daley-Yates" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bcp.12637" "Revista" => array:6 [ "tituloSerie" => "Br J Clin Pharmacol" "fecha" => "2015" "volumen" => "80" "paginaInicial" => "372" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25808113" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled fluticasone furoate/vilanterol does not affect hypothalamic-pituitary-adrenal axis function in adolescent and adult asthma: randomised, double-blind, placebo-controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Allen" 1 => "I. Schenkenberger" 2 => "R. Trivedi" 3 => "J. Cole" 4 => "W. Hicks" 5 => "N. Gul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/crj.12026" "Revista" => array:6 [ "tituloSerie" => "Clin Respir J" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "397" "paginaFinal" => "406" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23578031" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005500000012/v2_201912171000/S1579212919302939/v2_201912171000/en/main.assets" "Apartado" => array:4 [ "identificador" => "49862" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005500000012/v2_201912171000/S1579212919302939/v2_201912171000/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919302939?idApp=UINPBA00003Z" ]
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