دوره 32، شماره 278: هفته سوم اردیبهشت ماه 1393:342-358

ایمنی و اثربخشی داروی Ciclesonide در مقایسه با داروهای Fluticasone، Budesonide و Beclomethasone برای درمان بیماری آسم پایدار در ایران (مرور جامع مطالعات)

زهرا زالی, علی اکبری ساری, بهاره یزدی‌زاده, علیرضا حسینی, سید احمد طباطبایی

چکیده


مقدمه: Ciclesonide یک کورتیکو استروئید غیر هالوژنه است که برای درمان آسم پایدار استفاده می‌شود. این مطالعه با هدف مقایسه‌ی ایمنی و اثربخشی این دارو در مقایسه با داروهای رایج مورد استفاده در ایران شامل Fluticasone، Budesonide و Beclometasone برای درمان آسم پایدار انجام شد.

روش‌ها: مهم‌ترین بانک‌های اطلاعاتی الکترونیکی پزشکی شاملScopus، Web of science، CINHAL Cochrane، Library و Pubmed در نوامبر 2012 برای یافتن مطالعات RCT (Randomised controlled trial) و مروری منظم با كلید واژه‌های «CIC or Ciclesonide or Alvesco or Pregnenedion» و «Persistent asthma or Asthma» (Title) جستجو شد. در مواردی که نیاز به متاآنالیز بود، از نرم‌افزار Review manager استفاده شد.

یافته‌ها: در ابتدا 567 مطالعه وارد گردید که در نهایت بعد از حذف موارد تکراری، 18 RCT و 5 مطالعه‌ی مروری انتخاب شد. کیفیت زندگی در نسبت دوز 1:1 بهبودی بیشتری در گروه Ciclesonide نسبت به Fluticasone دارد و عارضه‌ی جانبی کاندیازیس دهانی نیز در گروه Ciclesonide کمتر از گروه Fluticasone بود و Ciclesonide در دوز بالا، اثر کمتری بر سرکوب آدرنال داشت. Peak expiratory flow صبح در نسبت دوز 1:1 در داروی Ciclesonide بیشتر از Budesonide بود؛ اما از نظر بالینی اهمیتی نداشت. در متغیرهای حمله‌ی آسمی، رتبه‌ی کنترل آسم و روزهای بدون علامت، تفاوتی مشاهده نشد.

نتیجه‌گیری: تفاوت Ciclesonide با Fluticasone در بهبود کیفیت زندگی و کاهش قارچ دهانی می‌باشد. Peak expiratory flow صبح در نسبت دوز 1:1 در داروی Ciclesonide بیشتر از Budesonide می‌باشد که از نظر بالینی اهمیتی ندارد. شواهد کافی در مورد مقایسه‌ی این دارو با Beclomethasone وجود ندارد.


واژگان کلیدی


ایمنی؛ اثربخشی؛ Ciclesonide؛ آسم؛ مرورسیستماتیک

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