SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

9/21/06

Ciclesonide more effective than budesonide in treating persistent asthma

Summary
Background – Ciclesonide (Cic) is a recently developed inhaled corticosteroid (ICS) pre-drug, metabolized in the lower airways to an active agent. It has been remarkably safe in previous studies. However, its efficacy compared to established ICS agents such as budesonide (Bud) in persistent asthma (PA) is less well defined.

Findings – Ukena et al of the Bremen Clinic in Germany and other sites compared Cic vs Bud, each inhaled in doses of 400 microg once daily, in 399 patients with PA. After a study period of 12 weeks, both treatments has improved the FEV-1 markedly from baseline (p<0.0001) with a moderately greater improvement in the Cic-treated than in the Bud- treated patients (p=0.02). The FVC and peak expiratory flow rates also increased more in the Cic-treated patients (p=0.02 – 0.03). Peak flow rates also started increasing earlier with Cic treatment (day 2) than with Bud treatment (day 7).

Both Cic and Bud were well tolerated with no decrease in urinary cortisol levels.

Reference
Pulm Pharmacol Ther 2006; July 11, E pub

Editor's Comments
Previous studies have shown that Cic appears superior to other ICS when high doses are needed for asthma control because of the lower incidence of systemic adverse effects of Cic. The study described above suggests that Cic is likely more effective in PA than the commonly used Bud when more moderate doses are compared.

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