Comparison the Change of Lung Function between Morning and Evening Dosing of Once-daily Inhaled Corticosteroids in Patients with Asthma: A Systemic Review and Meta-analysis

RATIONALE: Once-daily inhaled corticosteroids (ICS) have been widely used as first-line therapy in patients with asthma. This study was performed to compare clinical efficacy in lung function of ICS administered once-daily in the morning or evening in these patients.

METHODS: MEDLINE, EMBASE, and Cochrane Central Register were searched for relevant clinical trials to review. The primary outcome was lung function, such as trough forced expiratory volume in 1 second (FEV1) and PEF (peak expiratory flow) at endpoint.

RESULTS: A total of eight RCTs involving 1,234 patients were analyzed. The total number of once-daily ICS administered morning and evening was 628 and 606, respectively. Pooled estimates showed that ICS administered once-daily in the evening resulted in mild improvements in trough FEV1 and morning PFE at endpoint than morning dosing (mean difference [MD], 0.05L; 95% confidence interval [CI] 0.01 to 0.09; P = 0.026; I² = 22.5% and MD, 13.92 L/min; 95% CI 5.77 to 22.06; P = 0.001; I² = 13%, respectively). In evening PEF and mean daily PEF at endpoint, there appeared to be no differences between morning and evening dosing. And the number of the change of using rescue medicine and the incidence of adverse events in once-daily ICS was not significantly different between two dosing times.

CONCLUSIONS: Compared with the morning dosing, ICS administered once-daily in the evening seemed to provide some benefits in lung function of trough FEV1 and morning PEF at endpoint in patients with asthma.