The drug of choice for initial therapy is amphotericin B while posaconazole or isavuconazole can be used for step-down therapy
(30) In those who have attained complete symptom control after three months, step-down therapy
to on-demand or complete discontinuation of PPIs may be successful in over 50% of patients.
The availability of both intravenous and oral formulations of solithromycin would enable physicians to step-down therapy
from IV to oral administration with the same antibiotic.
Compared with continued combination therapy, LABA step-down therapy
was associated with an average 0.24-point drop in Asthma Quality of Life Questionnaire scores for control of asthma, 9.2% fewer symptom-free days, and an average of 0.71 more puffs /day from a rescue bronchodilator.
Major Finding: Compared with combination long-acting beta-agonist and inhaled corticosteroid therapy for controlled refractory asthma, LABA step-down therapy
was associated with an average 0.24-point drop in Asthma Quality of Life Questionnaire scores for control of asthma, 9.2% fewer symptom-free days, and an average of 0.71 more puffs/day from a rescue bronchodilator.
For patients with well-controlled asthma who are on a daily controller medication, half of the respondents endorsed the recommended evaluation at 3-6 months for consideration of step-down therapy
. However, the other half reported waiting a year or never stepping down therapy.
* For most patients with chronic heartburn and regurgitation, step-down therapy
to the lowest effective dose of proton pump inhibitors (PPIs) or treatment with a histamine-2 receptor antagonist (H2RA) is a reasonable, cost-effective approach.
Health care systems and insurance providers encouraged short-term use of PPIs, either prior to [H.sub.2] receptor antagonists (step-down therapy
) or only after failure of [H.sub.2] receptor antagonists (step-up therapy).
SAN DIEGO -- Once-a-day step-down therapy
can be an option for patients with mild, persistent asthma that has been stabilized by an inhaled corticosteroid, according to preliminary results from a 500-patient clinical trial presented at the international conference of the American Thoracic Society.
Peura: What's happened to step-up and step-down therapy
? Managed care organizations in my area often require that we document treatment failure with an He blocker before starting a PPI regimen.
Given that only half of the patients actually received the intervention, an on-treatment analysis would be helpful in determining whether or not step-down therapy
would result in deterioration of asthma control, though this type of analysis was not performed.