Morning vs Evening ICS Dosing in Asthma: Efficacies Compared

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society’s International Conference, taking place in San Diego, California. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2018.

SAN DIEGO — At the American Thoracic Society 2018 International Meeting held May 18-23 in San Diego, California, researchers from South Korea presented efficacy findings from a meta-analysis comparing morning and evening dosing of once-daily inhaled corticosteroids (ICS) in patients with asthma. 

While some literature exists on the timing of dosing once-daily ICS in patients with asthma, the efficacy of morning vs evening dosing has still not been established. The study investigators aimed to examine the differences in efficacy between ICS given once daily in the morning vs the evening in patients with asthma. 

A search of Medline, EMBASE, and the Cochrane Central Register identified 8 trials (N=1234). The primary outcome was lung function as measured by changes in forced expiratory volume in 1 second (FEV1) and peak expiratory flow (morning, evening, and daily). In addition, the researchers measured the change in use of rescue medicines and the rate of adverse events. 

Of the total ICS doses, 628 were administered in the morning and 606 in the evening. The analysis indicated that ICS given once daily in the evening led to mild improvements in trough FEV1 at end point vs ICS given in the morning (mean difference [MD] 0.05 L; 95% CI, 0.01-0.09; P =.026). 

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Moreover, ICS dosed in the evening resulted in statistically significant increases in morning peak expiratory flow vs morning dosing (MD 13.92 L/min; 95% CI, 5.77-22.06). This difference was not seen, however, for evening (MD 6.06 L/min; 95% CI, −1.81 to 13.93) or mean daily peak expiratory flow (MD 7.53 L/min; 95% CI, −0.29 to 15.35). 

Regarding the use of rescue medicines, there was no significant difference between the morning and evening dose groups (MD −0.31; 95% CI, −0.66 to 0.55). The investigators also observed no significant difference in the incidence of adverse events between the two arms (34.8% vs 31.9%; risk ratio [RR] 0.92; 95% CI, 0.76-1.11). 

The findings from the systematic review showed some benefit in trough FEV1 and morning peak expiratory flow when ICS was given once daily in the evening. “Because the change in use of rescue medicine at end point and the incidence of adverse events with once-daily ICS were not significantly different between the 2 dosing times, it would not be harmful to advise once-daily administration of an ICS in the evening,” concluded lead author Gil Myeong Seong, MD, from Jeju National University Hospital in Jeju, South Korea.

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Seong G, Lee J, Song J. Comparison of clinical efficacy between morning and evening dosing of once-daily inhaled corticosteroids in patients with asthma: a systemic review and meta-analysis. Presented at: American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, California. Abstract 4833.