Fluocortin Butyl

Background: Transendothelial migration of cells to sites of inflammation is a hallmark of the allergic reaction. The adhesion cascade involves the initial expression of the adhesion molecule E‐selectin on endothelial cells. The aim of the study was to determine the efficacy of a 30‐min preincubation of the glucocorticosteroids (GCS) fluticasone, prednisolone, and fluocortin butyl on allergen‐ and interleukin (IL)‐1β‐induced E‐selectin expression in allergic rhinitis.Methods: Freshly taken nasal inferior turbinate mucosa of 19 subjects with allergic rhinitis was cut into small cubes and preincubated for 30 min with prednisolone (n=6), fluticasone (n=5), and fluocortin butyl (n=3) in different concentrations, followed by allergen exposure at a concentration of 1000 BU/ml for 1 and 2 h. Additionally, fluticasone‐preincubated tissues were exposed to recombinant human rhIL‐1β (n=5) at a concentration of 2 pg/ml. The expression of E‐selectin was assessed by immunohistochemistry (APAAP technique) and computerized image evaluation.Results: In this model, E‐selectin expression was significantly upregulated by allergen and rhIL‐1β within 1 and 2 h. After 30‐min preincubation with prednisolone and fluocortin butyl at drug concentrations of 10−8 mol/l, we found a significant (≥50%) reduction of the E‐selectin expression after 1 and 2 h. Allergen‐induced E‐selectin expression was nearly abolished at concentrations of 10−5 (prednisolone) and 10−4 mol/l (fluocortin butyl). Fluticasone significantly inhibited E‐selectin expression by ≥50% at concentrations of 10−14 and 10−12 mol/l after 1 and 2 h, and abolished E‐selectin induction at concentrations of 10−12 and 10−10 mol/l, respectively. Exposure of mucosal cubes to rhIL‐1β (n=5) also induced rapid upregulation of E‐selectin expression, an effect which could be only partially suppressed by fluticasone preincubation at concentrations of 10−10 mol/l.Conclusions: Allergen‐induced E‐selectin expression is significantly and rapidly inhibited by GCS preincubation, fluticasone being more potent than prednisolone and fluocortin butyl. We suggest that this rapid effect is mainly indirect, possibly by inhibition of allergen‐induced cytokine release.

The purpose of this study was to compare, from a societal perspective, the cost effectiveness of topical prednicarbate 0.25% and fluocortin 0.75% in the treatment of inflammatory dermatoses, such as dermatitis and eczema, in Spain. Effectiveness and tolerability were determined by means of a meta-analysis of 17 randomised double-blind controlled clinical trials, using a MEDLINE search and a second-level reference search. The data were obtained on the basis of a per-protocol assessment system, and the Mantel-Haenszel method (as modified by Peto) was used to make the statistical analysis. In terms of economic assessment, a model was developed in which the expected total cost was determined by the cost of the medicine (adjusted to the recommended dosage) plus the costs derived from the ineffectiveness and/or adverse effects associated with the different treatments. A sensitivity analysis was carried out on the basis of changes in: (i) clinical effectiveness; (ii) price of prednicarbate; (iii) incidence of adverse reactions; (iv) costs associated with ineffectiveness and/or adverse effects; and (v) the regimen under which prednicarbate was administered. The meta-analysis showed that there was a statistically significant difference between the 2 alternatives (p = 0.001). The value of a combined odds ratio [and 95% confidence interval (95% CI)] for the combined studies of prednicarbate was 1.54 (95% CI 1.10 to 2.15), compared with 0.73 (95% CI 0.60 to 0.89) for fluocortin relative to moderate or moderate-to-high potency corticosteroids. Effectiveness was 84.9% for prednicarbate and 69.7% for fluocortin, while frequency of adverse effects was 3.5% for prednicarbate and 4.9% for fluocortin. The total expected cost per patient treated was found to be 4600 Spanish pesetas (Pta) [$US37.10; 1996 values] for prednicarbate and Pta5778 ($US46.60; 1996 values) for fluocortin. The total expected cost per patient successfully treated was Pta5608 ($US45.20) for prednicarbate and Pta8680 ($US70) for fluocortin. Prednicarbate has been shown to have a favourable cost-effectiveness ratio, when compared with fluocortin, for the treatment of dermatitis and eczema in Spain. Additional pharmacoeconomic studies on topical corticosteroids are required, including the use of new variables, long term analysis and/or the measurements of the effect of the drug on patients' quality of life.