SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
8/17/05
Maintenance of asthma control with inhaled ciclesonide
Summary
Background - Most guidelines recommend treatment of persistent asthma (PA) with an inhaled corticosteroid (ICS). However, ICS used in high doses may lead to adverse systemic effects after absorption from the lungs. Ciclesonide (Cicl) is a novel ICS, a prodrug converted in the lower airways into a metabolite with potent anti-inflammatory effects. When this metabolite is eventually absorbed systemically from the lungs, it is 99% bound to plasma proteins thereby not binding to corticosteroid receptors on systemic tissues. The Cicl metabolite is also cleared rapidly from the circulation. Thus, no adverse systemic effects are seen during treatment with even high doses of Cicl. Because Cicl is inactive in the pharynx after inhalation, the incidence of adverse effects in the upper airways is also very low.
Findings - Chapman et al of several institutions carried out a randomized, double blind comparison of substituting: 1) Cicl 160 microg/day; 2) Cicl 640 microg/day or 3) placebo for the pre-existent ICS therapy in 329 adults with PA adequately controlled on that existent ICS therapy.
After 12 weeks of such a comparison, the peak flow (PEFR) measurements and FEV-1 remained unchanged in patients receiving either dose of Cicl. In contrast, the PEFR and FEV-1 decreased significantly in those treated with placebo (p<0.0005). There was no significant difference in efficacy of the 160 and 640 doses of Cicl. There was no alteration in plasma and urinary cortisol levels in those treated with Cicl. No oral candidiasis was observed.
Reference
Allergy 2005;60:330-37
Editor's Comments
These findings add to a body of evidence convincingly showing the efficacy of Cicl in PA without evidence of either pharyngeal or systemic adverse effects. It will be of considerable interest to study the efficacy of Cicl used in higher daily doses for those with more severe PA. Previous studies have shown no adverse effects of such higher Cicl doses on the HPA axis, while this axis was inhibited by similar doses of inhaled fluticasone.
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