The Effectiveness and Safety of Ciclesonide versus Fluticasone, Budesonide, and Beclomethasone in Treatment of Persistent Asthma: A Comprehensive Review of Literature

Document Type : Review Article

Authors

1 Department of Health Technology Assessment, School of Health, Tehran University of Medical Sciences, Tehran, Iran

2 Assistant Professor, Department of Health Management and Economics, School of Health, Tehran University of Medical Sciences, Tehran, Iran

3 Assistant Professor, Knowledge Utilization Research Center, Tehran University of Medical Science, Tehran, Iran

4 Associate Professor, Food and Drug Administration, Ministry of Health and Medical Education, Tehran, Iran

5 Associate Professor, Department of Pediatrics, Mofid Children Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Ciclesonide is a lung-activated inhaled corticosteroid that provides effective control of persistent asthma. This study aimed to evaluate the safety and effectiveness of this drug compared to commonly used drugs including fluticasone, budesonide or beclomethasone.Methods: The major medical electronic databases including Scopus, Web of Science, CINHAL, Cochrane Library and PubMed were searched in November 2012.Findings: 567 articles were found. After exclusion of duplicates and irrelevant articles, 11 randomized controlled trials (RCTs) and 5 systematic reviews were included. No significant difference was found between ciclesonide (CIC) with fluticasone propionate (FP), budesonide (BUD) and beclomethasone dipropionate (BDP) in lung function [forced expiratory volume in 1 second (FEV1) and am and pm peak expiratory flow (PEF)], asthma symptoms score, using rescue medicine and asthma exacerbation requiring use of systemic steroids. In addition, no significant difference was found in adverse events such as pharyngitis, rhinitis, upper respiratory infection, and withdrawal from the study due to adverse events or lack of efficacy. The quality of life score favored ciclesonide versus fluticasone. Candidiasis was less frequent with ciclesonide versus fluticasone. Change in the morning PEF between ciclesonide and beclomethasone dipropionate/budesonide was not clinically significant.Conclusion: Ciclesonide and budesonide and beclomethasone gave similar results in safety and effectiveness. Ciclesonide improved the quality of life and reduced the oral candidacies compared to fluticasone. There was limited evidence when comparing ciclesonide with beclometasone.

Keywords

References

  1. Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59(5): 469-78.
  2. Asher MI. Recent perspectives on global epidemiology of asthma in childhood. Allergol Immunopathol (Madr ) 2010; 38(2): 83-7.
  3. Braman SS. The global burden of asthma. Chest 2006; 130(1 Suppl): 4S-12S.
  4. Heidarnia MA, Entezari A, Moein M, Mehrabi Y, Pourpak Z. Prevalence of asthma symptom in Iran: a meta-analysis. Pajouhesh Dar Pezeshki 2007, 31(3): 217-25. [In Persian].
  5. Fazlollahi M, Moein M. National guidelines for asthma. Tehran, Iran: Ministry of Health and Medical Education, Deputy of Health, Center for Non-Communicable Diseases Control, National Committee of Asthema; 2009. [In Persian].
  6. Adams NP, Jones PW. The dose-response characteristics of inhaled corticosteroids when used to treat asthma: an overview of Cochrane systematic reviews. Respir Med 2006; 100(8): 1297-306.
  7. Dahl R, Engelstatter R, Trebas-Pietras E, Kuna P. A 24-week comparison of low-dose ciclesonide and fluticasone propionate in mild to moderate asthma. Respir Med 2010; 104(8): 1121-30.
  8. Buston KM, Wood SF. Non-compliance amongst adolescents with asthma: listening to what they tell us about self-management. Fam Pract 2000; 17(2): 134-8.
  9. Lasserson TJ, Cates CJ, Jones AB, Steele EH, White J. Fluticasone versus HFA-beclomethasone dipropionate for chronic asthma in adults and children. Cochrane Database Syst Rev 2005; (4): CD005309.
  10. Newman S, Salmon A, Nave R, Drollmann A. High lung deposition of 99mTc-labeled ciclesonide administered via HFA-MDI to patients with asthma. Respir Med 2006; 100(3): 375-84.
  11. Vogelmeier CF, Hering T, Lewin T, Sander P, Bethke TD. Efficacy and safety of ciclesonide in the treatment of 24,037 asthmatic patients in routine medical care. Respir Med 2011; 105(2): 186-94.
  12. Berger WE. Ciclesonide: a novel inhaled corticosteroid for the treatment of persistent asthma–a pharmacologic and clinical profile. Therapy 2005; 2(2): 167-78.
  13. Dusser D, McGoldrick H, Pieters WR, Luengo M, Hellwig M, Engelstatter R. Comparable efficacy of ciclesonide and fluticasone propionate and lower incidence of oropharyngeal candidiasis with ciclesonide in patients with well controlled moderate to severe persistent asthma. European Respiratory Journal 2007, 30(Suppl 51): 351s.
  14. Stoica IG, Archip M, Babu M. Ciclesonide once daily (80 mg/d, 160 mg/d) versus fluticasone propionate twice daily (250 mg/d) in the treatment of patients with persistent asthma. Proceedings of the European Respiratory Society Annual Congress; 2010 Sep 18-22; Barcelona, Spain.
  15. Bladgen M, Rozen D, Vereecken G, Gruss C, Lawo J, Engelstaetter R. Comparison of ciclesonide 160 mu g once daily with fluticasone propionate 250 mu g twice daily in maintenance therapy of patients with stable asthma. Allergy 2007; 62(Supplement s83): 144.
  16. Tamm M, Dusser D, Fernandez J, Hellwig M, Engelstaetter R. Efficacy and tolerability of ciclesonide compared with fluticasone propionate in patients with well-controlled moderate to severe persistent asthma. Allergy 2007; 62(Supplement s83): 144.
  17. Adrenal suppression and clinical harms by inhaled corticosteroids: a review of safety and guidelines. Ottawa, Ontario: Canadian Agency for Drugs and Technologies in Health; 2011.
  18. Manning P, Gibson PG, Lasserson TJ. Ciclesonide versus other inhaled steroids for chronic asthma in children and adults. Cochrane Database Syst Rev 2008; (2): CD007031.
  19. Jonas DE, Wines RCM, DelMonte M, Amick HR, Wilkins TM, Einerson BD, et al. 2011.
  20. Kokot M, Wojciechowski P, Stozek A, Rogoz A, Rys P, Plisko R, et al. A comparison of clinical efficacy and safety of ciclesonide with fluticasone in 1:1 and 1:2 dose ratios in the treatment of bronchial asthma (systematic review and meta-analisys). Value in Health 2010; 13(7): A319-A20.
  21. Kokot M, Wojciechowski P, Stozek A, Rogoz A, Rys P, Plisko R, et al. A comparison of clinical efficacy and safety of ciclesonide with budesonide in 1:1 and 1:2 dose ratios in the treatment of bronchial asthma (systematic review and meta-analisys). Value in Health 2010; 13(7): A319-A20.
  22. Adachi M, Ishihara K, Inoue H, Kudo K, Takahashi K, Morita Y, et al. Efficacy and safety of inhaled ciclesonide compared with chlorofluorocarbon beclomethasone dipropionate in adults with moderate to severe persistent asthma. Respirology 2007; 12(4): 573-80.
  23. Chylack LT, Jr., Gross GN, Pedinoff A. A randomized, controlled trial to investigate the effect of ciclesonide and beclomethasone dipropionate on eye lens opacity. J Asthma 2008; 45(10): 893-902.
  24. Ukena D, Biberger C, Steinijans V, von B, V, Malek R, Weber HH, et al. Ciclesonide is more effective than budesonide in the treatment of persistent asthma. Pulm Pharmacol Ther 2007; 20(5): 562-70.
  25. Vermeulen JH, Gyurkovits K, Rauer H, Engelstatter R. Randomized comparison of the efficacy and safety of ciclesonide and budesonide in adolescents with severe asthma. Respir Med 2007; 101(10): 2182-91.
  26. von BA, Engelstatter R, Minic P, Sreckovic M, Garcia Garcia ML, Latos T, et al. Comparison of the efficacy and safety of ciclesonide 160 microg once daily vs. budesonide 400 microg once daily in children with asthma. Pediatr Allergy Immunol 2007; 18(5): 391-400.
  27. Magnussen H, Hofman J, Staneta P, Lawo JP, Hellwig M, Engelstatter R. Similar efficacy of ciclesonide once daily versus fluticasone propionate twice daily in patients with persistent asthma. J Asthma 2007; 44(7): 555-63.
  28. Boulet LP, Bateman ED, Voves R, Muller T, Wolf S, Engelstatter R. A randomized study comparing ciclesonide and fluticasone propionate in patients with moderate persistent asthma. Respir Med 2007; 101(8): 1677-86.
  29. Bateman ED, Linnhof AE, Homik L, Freudensprung U, Smau L, Engelstatter R. Comparison of twice-daily inhaled ciclesonide and fluticasone propionate in patients with moderate-to-severe persistent asthma. Pulm Pharmacol Ther 2008; 21(2): 264-75.
  30. Knox A, Langan J, Martinot JB, Gruss C, Hafner D. Comparison of a step-down dose of once-daily ciclesonide with a continued dose of twice-daily fluticasone propionate in maintaining control of asthma. Curr Med Res Opin 2007; 23(10): 2387-94.
  31. Agertoft L, Pedersen S. Lower-leg growth rates in children with asthma during treatment with ciclesonide and fluticasone propionate. Pediatr Allergy Immunol 2010; 21(1 Pt 2): e199-e205.
  32. Derom E, Louis R, Tiesler C, Engelstaetter R, Joos GF. Comparison of systemic and clinical effects of inhaled ciclesonide and fluticasone propionate in moderate to severe asthma. Proceedings of the American Thoracic Society International Conference; 2008 May 16-21; Toronto, ON, Canada.
  33. Quon BS, Fitzgerald JM, Lemiere C, Shahidi N, Ducharme FM. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev 2010; (12): CD007524.
  34. Pedersen S, Engelstatter R, Weber HJ, Hirsch S, Barkai L, Emeryk A, et al. Efficacy and safety of ciclesonide once daily and fluticasone propionate twice daily in children with asthma. Pulm Pharmacol Ther 2009; 22(3): 214-20.
  35. Lipworth BJ, Kaliner MA, LaForce CF, Baker JW, Kaiser HB, Amin D, et al. Effect of ciclesonide and fluticasone on hypothalamic-pituitary-adrenal axis function in adults with mild-to-moderate persistent asthma. Ann Allergy Asthma Immunol 2005; 94(4): 465-72.
  36. Molimard M, Girodet PO, Pollet C, Fourrier-Reglat A, Daveluy A, Haramburu F, et al. Inhaled corticosteroids and adrenal insufficiency: prevalence and clinical presentation. Drug Saf 2008; 31(9): 769-74.
  37. Goldbloom E, Ahmet A. Adrenal suppression: An under-recognized complication of a common therapy. Paediatr Child Health 2010; 15(7):
  38. -2.
  39. Dyer MJ, Halpin DM, Stein K. Inhaled ciclesonide versus inhaled budesonide or inhaled beclomethasone or inhaled fluticasone for chronic asthma in adults: a systematic review. BMC Fam Pract 2006; 7: 34.
  40. Adams N, Bestall JM, Jones PW. Inhaled beclomethasone versus budesonide for chronic asthma. Cochrane Database Syst Rev 2002; (1): CD003530.
Journal of Isfahan Medical School
Volume 32, Issue 278 - Serial Number 278
January and February 2014
Pages 342-358

Files

History

  • Receive Date: 24 May 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics