Mometasone furoate is used for the long-term prevention of bronchospasm in patients with asthma.
Current guidelines include recommendations for assessing asthma severity and asthma control as principal components for effective management of asthma. Assessment of asthma severity is used principally to determine initial therapy; once therapy is initiated, asthma control is assessed to guide decisions about adjusting or maintaining therapy using a stepped-care approach.
In the stepped-care approach to antiasthmatic drug therapy, current asthma management guidelines and most clinicians recommend initiation of a controller drug such as an anti-inflammatory agent, preferably a low-dose orally inhaled corticosteroid (e.g., 88-264, 88-176, or 176 mcg of fluticasone propionate [or its equivalent] daily via a metered-dose inhaler in adolescents and adults, children 5-11 years of age, or children 4 years of age or younger, respectively) as first-line therapy for persistent asthma (i.e., patients with daytime symptoms of asthma more than twice per week, but less than once daily, and nocturnal symptoms of asthma 3 or 4 times per month), supplemented by as-needed use of a short-acting, inhaled β2-agonist. For equivalent orally inhaled dosages of corticosteroids, .
According to current asthma management guidelines, therapy with a long-acting β2-agonist such as salmeterol or formoterol generally is recommended in adults and adolescents who have moderate persistent asthma and daily asthmatic symptoms that are inadequately controlled following addition of low-dose inhaled corticosteroids to as-needed inhaled β2-agonist treatment. However, the National Asthma Education and Prevention Program (NAEPP) recommends that the beneficial effects of long-acting β2-agonists should be weighed carefully against the increased risk (although uncommon) of severe asthma exacerbations and asthma-related deaths associated with daily use of such agents. Current asthma management guidelines also state that an alternative, but equally preferred option for management of moderate persistent asthma that is not adequately controlled with a low dosage of inhaled corticosteroid is to increase the maintenance dosage to a medium dosage (e.g., exceeding 264 but not more than 440 mcg of fluticasone propionate [or its equivalent] daily via a metered-dose inhaler in adults and adolescents).
Maintenance therapy with an inhaled corticosteroid at medium or high dosages (e.g., exceeding 440 mcg of fluticasone propionate in adults and adolescents or 352 mcg of the drug in children 5-11 years of age [or its equivalent] daily via a metered-dose inhaler) and adjunctive therapy with a long-acting inhaled β2-agonist is the preferred treatment according to current asthma management guidelines for adults and children 5 years of age or older with severe persistent asthma (i.e., continuous daytime asthma symptoms, nighttime symptoms 7 times per week).
If asthma symptoms in patients with moderate to severe asthma are very poorly controlled (i.e., at least 2-3 exacerbations per year requiring oral corticosteroids), a short course of an oral corticosteroid (3-10 days) may be added to gain prompt control of asthma. Regular use of oral corticosteroids as add-on therapy in adults and children 5 years of age or older with severe asthma who are inadequately controlled with a high-dose inhaled corticosteroid, intermittent oral corticosteroid therapy, and a long-acting inhaled β2-agonist bronchodilator is suggested, based on consensus and clinical experience. A short (2-week) course of oral corticosteroids may be considered to confirm clinical response prior to implementing long-term oral corticosteroid therapy. Once long-term oral corticosteroid therapy is initiated, the lowest possible effective dosage (i.e., alternate-day or once-daily administration) should be used, and the patient should be monitored carefully for adverse effects. Once asthma is well controlled, repeated attempts should be made to reduce the oral corticosteroid dosage.
Well-controlled clinical studies have shown that oral inhalation of mometasone relieves symptoms of bronchial asthma and improves pulmonary function. Optimum symptomatic relief may require at least 1-2 weeks of continuous mometasone oral inhalation therapy. In corticosteroid-dependent patients, use of mometasone oral inhalation therapy may permit a substantial reduction in the daily maintenance dosage, or discontinuance, of the systemic corticosteroid.
In several studies in patients with mild to moderate asthma who were receiving short-acting β2-adrenergic agonists alone, mometasone furoate (220 mcg once or twice daily or 440 mcg once daily) produced greater improvements in pulmonary function (e.g., morning predose forced expiratory volume in 1 second [FEV1], morning or evening peak expiratory flow rate [PEFR]) than placebo. In adolescents and adults with mild to moderate asthma who were receiving inhaled corticosteroids, substitution of mometasone furoate (220 or 440 mcg once daily; 110, 220, or 440 mcg twice daily) for the previous inhaled corticosteroid (at existing or reduced dosage) maintained or improved pulmonary function (e.g., as assessed by morning predose FEV1). In pediatric patients 4-11 years of age with mild to moderate asthma who were receiving inhaled corticosteroids, substitution of mometasone furoate (110 mcg once or twice daily) for the previous inhaled corticosteroid improved pulmonary function (e.g., change in percentage of predicted FEV1 from baseline to end point).
In a 12-week, double-blind, placebo-controlled study in patients with severe persistent asthma who were receiving chronic oral therapy with prednisone (approximately 12 mg daily) usually in conjunction with inhaled corticosteroids, discontinuance of prednisone therapy was achieved in 40 or 0% of patients receiving mometasone furoate 440 mcg twice daily or placebo, respectively, following discontinuance of any previous inhaled corticosteroid therapy. At the study end point, prednisone dosage was decreased by 46% in patients receiving mometasone furoate 440 mcg twice daily and increased by 164% in those receiving placebo.
Orally inhaled mometasone should not be used for the primary treatment of severe acute asthmatic attacks or status asthmaticus when intensive measures (e.g., oxygen, parenteral bronchodilators, IV corticosteroids) are required.
(See Cautions: Contraindications.)Mometasone oral inhalation is not a bronchodilator, and patients should be warned that the drug should not be used for rapid relief of bronchospasm or other acute episodes of bronchospasm. (See Advice to Patients.)
For EENT and topical uses, and , respectively.