Dulera (Mometasone-Formoterol) for Chronic Asthma Treatment
Dulera (mometasone-formoterol) is an excellent choice for chronic asthma treatment in patients with moderate to severe persistent asthma (step 3 care or higher) as it combines an effective inhaled corticosteroid with a long-acting beta-agonist in a single device. 1
Mechanism and Efficacy
- Dulera combines mometasone furoate (an inhaled corticosteroid with high potency) with formoterol (a long-acting β2-agonist), providing both anti-inflammatory and bronchodilator effects in a single inhaler 1, 2
- Mometasone effectively improves lung function, reduces asthma symptom scores, and decreases rescue medication use in patients with persistent asthma 3
- The combination of mometasone and formoterol has been shown to be more effective than either component alone in improving lung function, asthma control, and reducing asthma deteriorations 2
- Once-daily evening dosing of mometasone has demonstrated significant improvements in pulmonary function, making Dulera's twice-daily regimen convenient and effective 4
Place in Therapy
- According to asthma management guidelines, ICS-LABA combinations like Dulera are recommended for patients with moderate to severe persistent asthma (step 3 care or higher) 1
- Inhaled corticosteroids are the cornerstone of therapy for persistent asthma, and mometasone is a potent ICS option with established efficacy 1, 3
- Long-acting β2-agonists like formoterol should never be used as monotherapy but are preferred adjunctive therapy to combine with ICS in patients 12 years and older whose asthma is not adequately controlled with ICS alone 1
- For patients with moderate to severe persistent asthma, the combination of ICS-LABA is more effective than increasing the dose of ICS alone 1, 2
Dosing Considerations
- Dulera is typically administered twice daily, with clinical trials demonstrating efficacy at doses of 100-400 μg mometasone with 10 μg formoterol 2
- In patients with moderate to severe persistent asthma uncontrolled on medium-dose ICS, Dulera 200 μg/10 μg twice daily significantly reduces asthma deteriorations and improves lung function 2
- For patients with severe persistent asthma uncontrolled on high-dose ICS, Dulera 400 μg/10 μg twice daily is effective in improving lung function and asthma control 2
Safety Profile
- Dulera has a safety profile consistent with its individual components, with no new or unexpected safety signals detected in clinical trials 2
- The systemic exposure of mometasone from Dulera MDI is lower compared to mometasone DPI (Asmanex Twisthaler), potentially reducing systemic side effects 5
- Common adverse effects include oral candidiasis, headache, pharyngitis, and dysphonia, similar to other ICS-LABA combinations 3, 2
Special Considerations
- For patients with cough variant asthma, inhaled corticosteroids like mometasone should be considered as first-line treatment 1
- In patients whose asthma remains uncontrolled on ICS-LABA therapy, assessment of airway inflammation can help identify those who may benefit from more aggressive anti-inflammatory therapy 1
- Recent guidelines suggest that ICS-formoterol combinations like Dulera may be used as both daily controller and reliever therapy (SMART approach) in patients 12 years and older with moderate to severe persistent asthma 1, 6
Potential Pitfalls and Caveats
- Long-acting β2-agonists should never be used as monotherapy for asthma control due to safety concerns 1
- Increasing use of rescue medication (more than twice weekly) generally indicates inadequate asthma control and the need to step up therapy 1
- When transitioning patients to Dulera, ensure they understand it is not for acute symptom relief alone and that they still need a separate rescue inhaler 1
- Monitor for potential local side effects such as oral candidiasis and dysphonia, and advise patients to rinse their mouth after use 3