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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
9/19/06
Soft steroids – a promising approach to asthma care
Summary
Background - Inhaled corticosteroids (ICS) have become a staple of controller therapy in asthma. However, concerns about possible systemic side effects and sometimes complex dosing schedules have often reduced compliance of patients with ICS therapy.
Findings - The pharmaceutical industry has tried for years to develop “soft” ICS which are convenient to use (once daily), effective, yet free of potential adverse systemic side effects. Most products have not reached clinical utility. However, 2 agents have looked quite promising. Ciclesonide is a pro-drug, converted by enzymes in the lower airways into an active ICS. In clinical trials to date, once daily use of ciclesonide in an aqueous formulation has been quite effective in asthma control with no systemic adverse effects. Loteprednol ebonite, an inactive metabolite soft steroid has been used successfully in the topical treatment of eye disorders with minimal adverse effects. It is now being investigated in ICS formulation in the treatment of asthma.
Reference
Pulm Pharmacol Ther 2006;16:321-5
Editor's Comments
In view of the expanding use of ICS for long time periods in asthma management, concerns about adverse systemic effects are understandable. I have previously reviewed meeting reports and published data about the very promising results of studies of ciclesonide. The active metabolite of this agent which is systemically absorbed from the lungs is bound almost completely to plasma proteins and is therefore not available in free form to bind to corticosteroid receptors in systemic tissues. Thus, the potential for adverse systemic effects is markedly reduced.
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