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How does ciclesonide compare with other inhaled steroids for chronic asthma?

A new review from the Cochrane Library to inform your clinical practice

A new review from the Cochrane Library to inform your clinical practice

Inhaled steroids are an integral part of asthma management, and act as an anti-inflammatory agent in the airways of the lung. These agents confer both significant benefit in terms of symptom management and improvement in lung function, but may also cause harm in terms of local and systemic side-effects. Ciclesonide is a novel steroid that is metabolised to its active component in the lung, making it potentially useful for reducing local side-effects.

Methods

This review set out to assess the efficacy and adverse effects of ciclesonide relative to those of other inhaled steroids in the management of chronic asthma.

We searched the Cochrane Airways Group register of trials with pre-defined terms. Additional searches of PubMed and www.clinicalstudyresults.org were undertaken. The literature searches for this review are current up to June 2007.

Randomised parallel or crossover studies were eligible for review. We included studies comparing ciclesonide with other steroids both at nominally equivalent dose or lower doses of ciclesonide.

Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials.

Results

Some 21 trials involving 7,243 participants were included. Equal daily doses of ciclesonide and beclomethasone or budesonide gave similar results for peak expiratory flow rates (PEF), although FVC was higher with ciclesonide. Data on FEV1 were inconsistent. Withdrawal data and symptoms were similar between treatments.

Compared with the same dose of fluticasone, data on lung function parameters (FEV1, FVC and PEF) did not differ significantly.

Paediatric quality of life score favoured ciclesonide. Candidiasis was less frequent with ciclesonide, although other side-effect outcomes did not give significant differences in favour of either treatment.

When lower doses of ciclesonide were compared to beclomethasone or budesonide, the difference in FEV1 did not reach significance but we cannot exclude a significant effect in favour of beclomethasone/budesonide.

Other lung function outcomes did not give significant differences between treatments. Paediatric quality of life scores did not differ between treatments. Adverse events occurred with similar frequency between ciclesonide and beclomethasone/budesonide. Comparison with fluticasone at half the nominal dose was undertaken in three studies, which indicated that FEV1 was not significantly different, but was not equivalent between the treatments.

Author's conclusion

The results of this review give some support to ciclesonide as an equivalent therapy to other inhaled steroids at similar nominal doses. The studies assessed low doses, in patients whose asthma required treatment with low doses of steroids. At half the dose of fluticasone and beclomethasone/budesonide, the effects of ciclesonide were more inconsistent.

The effect on candidiasis may be important to some people. The role of ciclesonide in asthma management needs further study, especially in paediatrics. Further assessment against fluticasone at a dose ratio of 1:2 is a priority.


The Cochrane Library contains high-quality, independent evidence to inform healthcare decision making. Cochrane Reviews represent the highest level of evidence on which to base clinical treatment decisions. The Cochrane Library contains thousands of answers to healthcare questions. It is published by Wiley-Blackwell for the Cochrane Collaboration (www.Cochrane.org), a UK-registered international charity, providing up-to-date information about the effects of healthcare. The Cochrane Library is available free for all UK residents thanks to funding provided by official sources. See www.thecochranelibrary.com Access to Cochrane for details. For more information contact freynold@wiley.com.

PEF rates were similar for ciclesonide and other inhaled corticosteroids PEF rates were similar for ciclesonide and other inhaled corticosteroids

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