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`Azelastine nasal spray for the treatment of allergic 8: nonallergic rhinitis
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`|
`
`Compared with other agents used to treat AR, azelastine nasal
`spray is more effective than oral antihistamines and intranasal
`levocabastine with comparable efficacy to intranasal fiuticasone
`propionate. Combination therapy with intranasal corticosteroids
`has provided some interesting results and has the potential to
`enhance clinical benefit.
`
`Five-year view
`The economic situation may influence the use of drugs in nonseri—
`ous diseases in the next few years: whereas both I-I1—receptor antago—
`nists or topical steroids are recommended as first—line treatment in
`AR, antihistamines are cheaper. For the same reason, combination
`therapies of oral antihistamines and nasal corticosteroids will hardly
`become market standard, despite their good pharmacological pro—
`file. Therefore, topically used antihistamines like azelastine will gain
`in importance, especially used on demand for moderate symptoms.
`The therapeutic power of H1—receptor antagonists is limited,
`especially if they have no activity on other pathways of the allergic
`
`inflammation process, such as azelastine. Therefore, it is still
`impossible to eliminate severe symptoms with this class of drugs
`and this will not change. That is the reason why several other com—
`pounds are in development with very different modes of action.
`Some of these are even linked to cancer treatment. However, there
`
`is no light at the end of the tunnel within the next 5 years.
`The improvement of specific immunotherapy in terms of toler—
`ability a_nd efficacy will lead to a more frequent use. Comedication
`of topically used antihistamines on demand will support
`immunotherapy in a beneficial manner.
`
`Financial & competing interests disclosure
`The authors have no relevant afiiliations orfinancial involvement with any
`organization or entity with afinancial interest in orfinancial conflict with
`the suhject matter or materials discussed in the manuscript. This includes
`employment, consultancies, honoraria, stock ownership or options, expert
`testimony, grants orpatents received orpending, or royalties.
`No writing assistance was utilized in the production ofthis manuscript.
`
`Key issues
`
`0 Rhinitis affects millions of people worldwide and its prevalence is increasing. Symptoms have a major negative impact on patients’
`health—related quality of life.
`0 Azelastine nasal spray is a topically administered second—generation antihistamine, indicated for the treatment of allergic rhinitis (adults
`and children 25 years of age) and nonallergic rhinitis (adults and children 212 years of age).
`0 Azelastine nasal spray dose can be tailored (i.e., one or two sprays/nostril twice daily) to suit individual patient needs, and it can be
`used on an as—needed basis without compromising clinical efficacy, which should improve tolerability and patient compliance.
`0 Compared with oral antihistamines, azelastine nasal spray has superior efficacy and has a more rapid onset of action in the treatment
`of allergic rhinitis. It is also effective in those patients who have previously failed to respond to oral antihistamines.
`0 Unlike oral antihistamines, azelastine nasal spray reduces nasal congestion without causing a sedative effect.
`0 With respect to intranasal corticosteroids, azelastine nasal spray demonstrates comparable efficacy to fluticasone propionate, with a
`faster onset of action.
`
`0 The combination of azelastine and fluticasone propionate nasal sprays reduce symptoms in allergic rhinitis patients more than either
`agent alone.
`0 Azelastine nasal spray exhibits superior efficacy to intranasal levocabastine and to mast cell stabilizers.
`0 Azelastine nasal spray is safe and well tolerated for up to 4 weeks in both adults and children.
`
`References
`Papers of special note have been highlighted as:
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`Horak 8: Zieglmayer
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`of drug delivery in patients with allergic
`and vasomotor rhinitis, particularly if
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`azelastine dose can be tailored to suit
`
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`16
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`17
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`
`Demonstrated that on—demand use of
`
`30
`
`azelastine nasal spray achieved acceptable
`clinical control of rhinitis symptoms but
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`inflammation, as observed at doses of
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`
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`Azelastine nasal spray for the treatment of allergic 8: nonallergic rhinitis
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`Website
`
`101 Global Allergy and Asthma European
`Network. News: quality management of
`biobanks: GAZLEN handbook for
`researchers
`
`WWW. ga2len.net
`
`°
`
`Provides all relevant publications
`concerning allergy rhinitis and asthma.
`
`Affiliations
`Friedrich Horak
`HNO — Universitatsklinik Wien,
`Wahringer Giirtel 18—20, A—1090 Vienna,
`Austria
`Tel; +43 140 400 3336
`Fax: +43 1789 7676
`friedrich.horak@vienna.at
`
`Ursula Petra Zieglmayer
`Allergy Center Vienna West,
`Huetteldorferstr. 46, 1150 Wien,
`Austria
`Tel; +43 198 241210
`Fax: +43 198 241211
`
`petra@zieglmayer.at
`
`WWW.CXp Cl‘[—l‘CVlCWS. COH1
`
`669
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`APOTEX_AZFL 0130205