Commentary: Dosage needs systematic and critical review

摘要

The systematic review by Holt and colleagues is in principle simple and straightforward. They would have been able to do an even more thorough job had they been provided with the data on individual patients from the studies, but their conclusion is convincing and important. With any new drug that has therapeutic activity, an appropriate dosage regimen must be worked out from a clear understanding of the pharmacokinetics and the dose-response relation. When these are known, sensible decisions can be made on the starting dosage, the minimum time to allow before increasing the dose, dose increments, and the maximum useful dose. Why did it take until now, from the first marketing of fluticasone in 1993, to discover that the maximum useful dosage for most cases is only about half of that hitherto recommended by guidelines and the manufacturer? How did the data emerge, and why were they not used earlier?