SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
9/23/05
Ciclesonide effect on allergen-induced asthmatic responses
Summary
Background - Ciclesonide (Cic) is a rather unique non-halogenated inhaled corticosteroids (ICS) which is biologically inactive until it is cleaved by esterases in the lower airway into a potent anti-inflammatory metabolite. Cic has been approved in the UK and Germany for the treatment of persistent asthma (PA) in doses of 80 and 160 mcg. The question arises whether Cic treatment can be effective in even lower doses.
Findings - Gauvreau et al of McMaster Univ in Canada investigated the effects of once daily dosing with Cic 40 microg, 80 microg and placebo on inhaled allergen induced early and late asthmatic reactions in mild allergen-sensitive asthma. Using a randomized, crossover protocol, they found treatment with Cic 80 microg decreased allergen induced early and late phase bronchoconstriction as well as sputum eosinophilia and serum levels of eosinophil cationic protein. Pre-treatment with Cic decreased the late asthmatic response and sputum eosinophil frequency.
Reference
J Allergy Clin Immunol 2005;116: 285-91
Editor's Comments
These findings suggest that Cic treatment at quite low doses has a significant protective effect. It remains to be seen whether these Cic doses will be sufficient to control moderate asthma. What is particularly encouraging is that these low doses of Cic should have little or no systemic adverse effects because the active Cic metabolite is almost completely bound to plasma proteins after absorption from the lungs into the circulation. Such protein based Cic cannot bind to corticosteroids receptors on systemic tissues. The Cic metabolite is then cleared rapidly from the systemic circulation.
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