Journal Club - ICS potency and therapeutic index


Calgary, Alberta


Apr 5, 2019

Discussion topic and resource: Inhaled corticosteroids: Potency dose equivalence and therapeutic index.  

Reference:  British Journal of Clinical Pharmacology (Sponsored by GlaxoSmithKline), pg 372-380, 80:3.
Lead by:  Dr. Tourin
Duration: 45 minutes
Discussion: This study focused on the comparison of pharmacological parameters and safety characteristics of different ICS used in treatment of asthma and COPD.  

Conclusion:  Current asthma treatment guidelines make assumptions about dose equivalence that position low doses as effective doses without significant risk of adverse , and high doses as those with an acceptable systemic adverse – effect profile . It is also recognized that most of the therapeutic benefit is achieved at low-mid doses and that not all patients benefit from high doses.  As a higher potency can improve the therapeutic index, both efficacy and safety should be considered when classifying inhaled corticosteroid regimens in terms of dose equivalence. Current asthma guidelines rely on a simple historical approach to dose equivalence but this is not appropriate for wider range of molecules, potencies and devices/formulations now available.

-Sheena Schindle, Rep (BI); Olga Tourin, MD; Tammy Glas, RRT; Andrew Li, RRT; Stephanie Dick LPN,  

Dr. Olga Tourin