Ciclesonide versus other inhaled steroids for chronic asthma in children and adults

Manning, Pat; Gibson, Peter G.; Lasserson, Toby J

doi:10.1002/14651858.cd007031

Cited by 22 publications

(22 citation statements)

References 70 publications

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“…In other trials, ciclesonide has been shown to be equivalent to fluticasone in increasing FEV1 [33]. The smaller effect of ciclesonide on small airway parameters, such as FEF25-75% and alveolar eNO, compared with fluticasone is even more surprising.…”

Section: Discussionmentioning

confidence: 92%

Particle size matters: diagnostics and treatment of small airways involvement in asthma

Cohen¹,

Postma²,

Douma³

et al. 2010

European Respiratory Journal

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Small airways are an important site of inflammation and obstruction in asthma, which contributes to the severity of airway hyperresponsiveness (AHR) that is usually measured by nebulisation of large-particle stimuli. We investigated whether small and large particle sizes of aerosolised adenosine monophospate (AMP) provoke similar severity of AHR. Additionally, effects of the small-particle inhaled corticosteroid (ICS) ciclesonide and large-particle ICS fluticasone on AHR to large-and small-particle size AMP were assessed.After a 4-week run-in period using open-label fluticasone (100 mg b.i.d.), 37 mild-to-moderate asthmatics underwent provocations with standard-size (3.7 mm), large-particle (9.9 mm) and smallparticle (1.06 mm) AMP. Subjects received 4-week ciclesonide (160 mg s.i.d.) or fluticasone (100 mg b.i.d.) treatment (double-blind and double-dummy) followed by large-and small-particle AMP provocation.Small-particle AMP induced a 20% decrease in forced expiratory volume in 1 s (FEV1) at a significantly higher dose than large-particle AMP. Ciclesonide and fluticasone had comparable effects on AMP provocations. Not all subjects reached the provocative concentration causing a 20% fall in FEV1 (PC20) at the highest AMP dose. In those who did, ciclesonide improved smallparticle AMP PC20 by 1.74 doubling doses (DD) (p50.03), whereas fluticasone did not. Conversely, fluticasone improved large-particle AMP PC20 significantly (1.32 DD; p50.03), whereas ciclesonide did not.Small-particle AMP provocation appears to be a promising tool to assess changes in small airway inflammation. Future adjustments are necessary taking into account the very small particle size used, with large exhaled fractions. In asthmatics reaching a PC20 with small-and largeparticle AMP provocations, ciclesonide improves hyperresponsiveness to small particle size AMP, and fluticasone to large particle size. This warrants further research to target provocations and treatment to specific airway sizes.

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Section: Discussionmentioning

confidence: 92%

Particle size matters: diagnostics and treatment of small airways involvement in asthma

Cohen¹,

Postma²,

Douma³

et al. 2010

European Respiratory Journal

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“…Guidelines recommend that fluticasone and ciclesonide be prescribed at similar nominal doses123615 based on equipotence in formal testing in randomized trials. Despite these recommendations, we found that in practice, ciclesonide was prescribed at lower doses than fluticasone and that fluticasone was typically prescribed at higher than recommended doses, corroborating findings from prior studies in the Netherlands, as well as New Zealand, the UK, and the USA 21223940.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical trials to date, ciclesonide showed similar efficacy as compared with fine-particle ICSs, such as fluticasone and budesonide (MMAD ~3 µm) at similar nominal doses for patients with persistent asthma 101516. However, these trials were generally 8-12 weeks in duration and focused on short-term improvement of lung function outcomes, thus they were unable to assess longer term fluctuations in asthma control and events, such as exacerbations.…”

Section: Introductionmentioning

confidence: 99%

Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

Postma

Dekhuijzen

Molen

et al. 2017

Allergy Asthma Immunol Res

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PurposeExtrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone).MethodsThis historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change.ResultsEach cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide.ConclusionsIn this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.

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“…Furthermore, perhaps as a consequence of the inactive inhaled compound, ciclesonide has a different adverse effect profile. Most markedly, a reduction in oral candidiasis of 75% when compared with FP has been demonstrated [52]. Second, ciclesonide is a small-particle ICS, thus reaching more distal airways of smaller caliber than ICS with larger particles.…”

Section: Market Reviewmentioning

confidence: 98%

“…A systematic review and meta-analysis of the clinical efficacy of ciclesonide in asthma was published in 2008. In that article, some support was found that ciclesonide is likely not to be inferior to other ICS, but more studies were warranted at that point [52]. More recently, in 2014, a fairly large step-down study of asthmatics comparing ciclesonide q.d.…”

Section: Market Reviewmentioning

confidence: 99%

Emerging corticosteroid agonists for the treatment of asthma

Westergaard¹,

Porsbjerg

Backer³

2015

Expert Opinion on Emerging Drugs

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Compared with drugs acting on other pathological pathways, research in GRAs for asthma is sparse. However, a few promising agents acting selectively on the GR are currently under investigation and may reach approval for asthma treatment. These drugs exhibit improved pharmacodynamic properties due to selectivity in the mechanism of action, including promotion of transrepression and reduction of transactivation. However, competition from already approved ICS and other emerging treatment options may lead to cessation of development of the new GRAs.

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Ciclesonide versus other inhaled steroids for chronic asthma in children and adults

Cited by 22 publications

References 70 publications

Particle size matters: diagnostics and treatment of small airways involvement in asthma

Particle size matters: diagnostics and treatment of small airways involvement in asthma

Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

Emerging corticosteroid agonists for the treatment of asthma

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