Differences Between Fluticasone and Mometasone
Both fluticasone and mometasone are potent synthetic corticosteroids with similar efficacy profiles, but mometasone has once-daily dosing compared to fluticasone's typically twice-daily administration, which may improve patient adherence. 1
Pharmacological Properties
Receptor Binding and Specificity
- Mometasone furoate has been shown in vitro to exhibit a binding affinity for the human glucocorticoid receptor that is approximately 1.5 times that of fluticasone 2
- However, mometasone is considerably less specific for the glucocorticoid receptor than fluticasone, showing significant activity at other nuclear steroid receptors 3:
- Mometasone is a very potent agonist of the progesterone receptor
- Mometasone displays partial agonist activity at the mineralocorticoid receptor
- Fluticasone is more selective for the glucocorticoid receptor with minimal activity at other steroid receptors
Dosing Schedule
- Fluticasone propionate is typically administered twice daily 1
- Mometasone furoate is administered once daily, which may improve patient adherence 1
Pharmacokinetics
- When switching between medications, fluticasone furoate requires a longer washout period (24 hours) compared to fluticasone propionate (6 hours) 1
- Both medications have similar physicochemical properties and structure-activity relationships 4
- Both have comparable systemic bioavailability when administered intranasally 4
Clinical Efficacy
Asthma Treatment
- In asthma management, both are effective inhaled corticosteroids (ICSs) and are considered first-line therapy for persistent asthma 5
- Clinical trials have shown that mometasone furoate 400 mcg twice daily is therapeutically equivalent to fluticasone propionate 500 mcg twice daily in patients with moderate-to-severe persistent asthma 6
- A dose of 200 mcg twice daily of mometasone provides clinical benefit comparable to 250 mcg twice daily of fluticasone 7
Allergic Rhinitis Treatment
- For allergic rhinitis, both medications effectively control symptoms 8
- In perennial rhinitis treatment, once-daily mometasone furoate 200 mcg was found to be at least as effective as once-daily fluticasone propionate 200 mcg 8
- Both medications showed similar percent reductions from baseline in nasal symptom scores (37% for mometasone and 39% for fluticasone) 8
Obstructive Sleep Apnea
- Both medications have shown benefits in patients with obstructive sleep apnea, particularly those with rhinitis and snoring 5
- Intranasal fluticasone and mometasone both can reduce the Apnea-Hypopnea Index (AHI) in patients with OSA 5
Safety Profile
Side Effects
- Both medications have similar safety profiles when used at recommended doses 1
- Neither significantly impacts bone mineral density or shows clinically meaningful HPA axis suppression at standard doses 1
- Local side effects such as nasal irritation and epistaxis are rare with both medications 1
- The incidence of oral candidiasis appears similar between equivalent doses of both medications 7
Practical Considerations
Formulations
- Both are available in various formulations including nasal sprays and inhalers
- Mometasone furoate is available in a dry powder inhaler (ASMANEX TWISTHALER) 2
- Fluticasone is available in both propionate and furoate forms 1
Patient Selection
- For patients requiring once-daily dosing to improve adherence, mometasone may be preferred 1
- For patients with conditions where progesterone or mineralocorticoid activity might be concerning, fluticasone may be preferred due to its greater receptor specificity 3
In summary, while both medications are effective corticosteroids with similar efficacy profiles, the choice between them may depend on dosing preference, specific formulation needs, and consideration of their slightly different receptor activity profiles.