***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : A prospect i ve , cross‐sectional , international survey was conducted among patients and physicians to identify symptom perception and the impact of allergic rhinitis ( AR ) on health‐related quality of life ( HRQoL ) . This paper presents the results from the USA WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The topical second generation anti-histamine azelastine hydrochloride ( AZE ) and the potent corticosteroid fluticasone propionate ( FP ) are well established first-line treatments in allergic rhinitis ( AR ) . • MP29 - 02 , a novel intranasal AZE and FP formulation , has been shown to control AR symptoms faster and better than st and ard intranasal AZE or FP . • The systemic bioavailabilities of marketed AZE and FP nasal spray products have been established at about 40 % and 1 % only , respectively . • For new combination medicinal products such as MP29 - 02 , the determination of possible pharmacokinetic ( PK ) drug-drug interactions between both active components and formulation-based bioavailability alterations is essential . WHAT THIS STUDY ADDS • This paper provides for the first time information on potential drug-drug interactions , AZE and FP bioavailability and disposition characteristics of each component administered by the novel nasal spray formulation MP29 - 02 . • The studies employed highly sensitive FP and AZE LC-MS/MS assays and could therefore be conducted with recommended therapeutic doses , thereby circumventing previously recognized draw-backs that required nasal bioavailability studies to be conducted using supra-therapeutic doses . • No significant PK drug-drug interaction between the active components AZE and FP was noted for MP29 - 02 . • AZE bioavailabilty was equivalent when MP29 - 02 data were compared with MP29 - 02-AZE-mono and Astelin ® . • Increased FP exposure was observed with MP29 - 02-based products compared with FP-BI . FP serum concentrations were generally very low with all investigational products suggesting no clinical ly meaningful pharmacodynamic differences in terms of systemic safety . AIM ( S ) To determine  azelastine hydrochloride ( AZE ) and fluticasone propionate ( FP ) bioavailabilities of the novel nasal spray combination product MP 29 - 02 , compared with MP29 - 02-based products containing only AZE ( MP29 - 02-AZE-mono ) , FP ( MP29 - 02-FP-mono ) , marketed AZE and FP single entity products ( Astelin ® and FP Boehringer-Ingelheim ; FP-BI ) . METHODS Two r and omized , three period , six sequence , three treatment crossover studies were conducted in healthy subjects . Study 1 administered 200 µg FP as MP29 - 02 , MP29 - 02-FP-mono or FP-BI . Study 2 administered 548 µg AZE as MP29 - 02 , MP29 - 02-AZE-mono or Astelin ® . Each dose consisted of two sprays/nostril . Serum FP and plasma AZE were followed over 24 ( FP ) and 120 h ( AZE ) and quantified by LC-MS/MS  . Peak ( C(max ) ) and total exposures AUC(0,t(last ) ) were compared between the treatments by anova . RESULTS Study 1 : Average FP C(max ) was very low with all products ( ≤ 10 pg ml(-1 ) ) . FP AUC(0,t(last ) ) point estimates ( 90 % CIs ) for MP29 - 02 : MP29 - 02-FP-mono and MP29 - 02 : FP-BI ratios ( % ) were 93.6 ( 83.6 , 104.7 ) and 161.1 ( 137.1 , 189.3 ) . Corresponding ratios for C(max ) were 91.0 ( 82.5 , 100.4 ) and 157.4 ( 132.5 , 187.1 ) . Study 2 : AZE AUC(0,t(last ) ) point estimates ( 90 % CIs ) for MP29 - 02 : MP29 - 02-AZE-mono and MP29 - 02  : Astelin ® ratios ( % ) were 98.8 ( 91.0 , 107.4 ) and 105.5 ( 95.6 , 116.4 ) . Corresponding outcomes for C(max ) were 102.7 ( 92.1 , 114.4 ) and 107.3 ( 92.6 , 124.3 ) . CONCLUSIONS No interactions of AZE and FP were found with the MP29 - 02 formulation . Azelastine bioavailability was similar for MP29 - 02 and Astelin ® . Maximum and total FP exposure was higher for MP29 - 02-based products compared with FP-BI . FP concentrations were generally very low with all investigational products and did not suggest clinical ly meaningful differences concerning systemic safety Measurement of domiciliary nasal peak inspiratory flow rate ( PIFR ) may have a role in the objective assessment of treatment response in seasonal allergic rhinitis ( SAR ) BACKGROUND Azelastine hydrochloride is an H1-receptor antagonist with antiinflammatory properties that is available in the US as Astelin Nasal Spray for the treatment of seasonal allergic rhinitis . The symptoms of seasonal allergic rhinitis can initially be treated with monotherapy using either an antihistamine or an intranasal corticosteroid . Patients whose symptoms do not respond adequately are often prescribed a combination of both an antihistamine and an intranasal corticosteroid . OBJECTIVE Three multicenter , r and omized , double-blind studies were conducted to determine whether patients with moderate-to-severe symptoms of seasonal allergic rhinitis who had responded inadequately to monotherapy with either an oral antihistamine or an intranasal corticosteroid , and who were c and i date s for combination therapy with both an oral antihistamine and an intranasal corticosteroid  , could be effectively treated with azelastine nasal spray monotherapy . METHODS Following a 1- to 2-week washout period , patients were r and omized to 7 days of double-blind treatment with either azelastine nasal spray ( 2 sprays per nostril bid , 1.1 mg/day ) monotherapy or combination therapy with oral loratadine ( Claritin , one 10-mg tablet/day ) plus intranasal beclomethasone dipropionate monohydrate ( Beconase AQ , 2 sprays per nostril bid , 336 microg/day ) . Efficacy was determined at the end of the study by both a physician assessment of the need for additional anti-rhinitis medication and a patient global evaluation of therapeutic effectiveness . The three studies were conducted at 71 investigational sites during the 1998 spring allergy season . Three separate studies were conducted to verify the reproducibility of the new study design . RESULTS In all three studies a total of 1,070 patients were r and omized to double-blind treatment . There were no statistically significant differences in the percentage of patients treated with azelastine nasal spray versus patients treated with a combination of loratadine tablets and beclomethasone nasal spray who did not require additional anti-rhinitis medication ( 32 % to 45 % and 39 % to 46 % , respectively ) . The patient global evaluation indicated that 77 % to 84 % of the patients treated with azelastine nasal spray had symptomatic improvement and 85 % to 90 % of the patients treated with loratadine tablets and beclomethasone nasal spray had symptomatic improvement . The most commonly reported adverse experience with azelastine nasal spray was a transient aftertaste ( 8 % ) , while the most commonly reported adverse experience with loratadine tablets and beclomethasone nasal spray in combination was headache ( 6 % ) . CONCLUSIONS Based on the percentage of patients not requiring additional antirhinitis medication and the patient assessment of efficacy , azelastine nasal spray monotherapy was as effective as the combination of oral loratadine plus intranasal beclomethasone in treating moderate-to-severe symptoms of seasonal allergic rhinitis BACKGROUND AND OBJECTIVE MP29 - 02 ( Dymista ) , a novel intranasal formulation of azelastine hydrochloride ( AZE ) and fluticasone propionate ( FP ) , is significantly better than first-line therapy for the treatment of moderate-to-severe seasonal allergic rhinitis ( SAR ) , and is well tolerated following 52 weeks of continuous use in chronic rhinitis . The aim of this study was to evaluate the long-term efficacy of MP29 - 02 versus FP in patients with chronic rhinitis . PATIENTS AND METHODS In total , 612 chronic rhinitis patients ( perennial allergic rhinitis [ PAR ] , n = 424 ; nonallergic rhinitis , n=188 ) aged 12 years or older were enrolled into this open-label , parallel-group study and r and omized to MP29 - 02 ( 1 spray/nostril bid ) or FP nasal spray ( 2 sprays/nostril qd ) for 52 weeks . Efficacy was assessed by change from baseline in PM reflective total nasal symptom score ( rTNSS ) , time to first achieve 100 % PM rTNSS reduction from baseline , and percentage of symptom-free days in the total and PAR population s posthoc . RESULTS MP29 - 02 reduced patients ' PM rTNSS from baseline significantly more than FP , from Day 1 up to and including week 28 ( -2.88 vs -2.53 ; P = .0048 ) , with treatment difference maintained for 52 weeks . Fluctuation in significance after week 28 might be explained , at least in part , by decreasing sample size , permitted according to ICH guidelines . By Day 1 almost twice as many MP29 - 02- patients were symptom free . After 1 month , 71.1 % of MP29 - 02 patients experienced 100 % rTNSS reduction ( 60.3 % for FP ) , and did on a median of 9 days faster ( P=.0024 ) . Over 52 weeks MP29 - 02 patients experienced 8.4 % more symptom-free days ( P = .0005 ) . These results were mirrored in the PAR sub population . CONCLUSION These results confirm MP29 - 02 's wide therapeutic spectrum and assert its consistent superiority over an intranasal corticosteroid Background : It is unclear what constitutes a clinical ly meaningful response for allergic rhinitis ( AR ) outcomes . The objectives of these post hoc analyses were ( 1 ) to define a clinical ly meaningful response using novel efficacy analyses ( including a responder analysis ) , and ( 2 ) to compare the efficacy of MP29 - 02 [ a novel intranasal formulation of azelastine hydrochloride ( AZE ) and fluticasone propionate ( FP ) ] with commercially available FP , AZE and placebo in seasonal AR ( SAR ) patients , using these novel analyses . Methods : 610 moderate-to-severe SAR patients ( ≥12 years old ) were r and omized into a double-blind , placebo-controlled , 14-day , parallel-group trial . Change from baseline in the reflective total nasal symptom score ( rTNSS ) over 14 days was the primary outcome . Post hoc endpoints included the sum of nasal and ocular symptoms ( rT7SS ) , efficacy by disease severity and by predominant nasal symptom , and a set of responder analyses . Results : MP29 - 02 most effectively reduced rT7SS ( relative greater improvement : 52 % to FP ; 56 % to AZE ) and both nasal and ocular symptoms irrespective of severity . More MP29 - 02 patients achieved a ≥30 , ≥50 , ≥60 , ≥75 and ≥90 % rTNSS reduction , which occurred days faster than with either active comparator ; MP29 - 02 alone was superior to placebo at the ≥60 % ( or higher ) threshold . One in 2 MP29 - 02 patients achieved a ≥50 % rTNSS reduction and 1 in 6 achieved complete/near-to-complete response . Only MP29 - 02 was consistently superior to placebo for all patients , whatever their predominant symptom . Conclusions : MP29 - 02 provided faster and more complete symptom control than first-line therapies . It was consistently superior irrespective of severity , response criteria or patient-type , and may be considered the drug of choice for moderate-to-severe AR . These measures define a new st and ard for assessing relevance in AR BACKGROUND To our knowledge , there are no published studies that evaluated the efficacy of azelastine hydrochloride nasal spray in combination with an intranasal corticosteroid , although anecdotal reports of the use of these agents in combination are common . OBJECTIVE To determine if greater efficacy could be achieved with the intranasal antihistamine azelastine and the intranasal corticosteroid fluticasone propionate used concurrently compared with the effic 
    Output:
    
Intranasal corticosteroid plus oral antihistamine have similar efficacy to intranasal corticosteroid alone , greater efficacy than oral antihistamines alone or placebo in reducing nasal symptoms for AR patients .
Intranasal corticosteroid plus intranasal antihistamine are significantly superior to either therapy given alone , or placebo